Dealer Application Submit form to apply After review, our team will contact you. Completion of this application does not guarantee acceptance. Name(Required) First Last Email(Required) Phone(Required)Company Name(Required) Website(Required) Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Years In Business(Required)Tax ID Number(Required)Social Media Account Names Do you have a storefront?(Required) Yes No Describe Your Business and Clientele:(Required)Do you sell other artificial habitat? If yes, which products?(Required)Please provide us additional information that will help us better understand your business:CAPTCHA