New Manufacturers Representatives Account Qualification Form

Global Pet Expo Starts In...

			:		:
DAYS		HOURS	:	MINUTES	:	SECONDS

February 29-March 2, 2012
Orange County Convention Center
Orlando, Florida

American Pet Products Association
255 Glenville Road
Greenwich, CT 06831
Phone: 203.532.0000
Toll Free: 800.452.1225
Fax: 203.532.0551
www.americanpetproducts.org

APPA's Washington D.C. Office
Suite 100
1900 K Street NW
Washington, DC 20006
Phone: 202.496.7888

Pet Industry Distributors Association
2105 Laurel Bush Rd., Suite 200
Bel Air, MD 21015
Phone: 443-640-1060
Fax: 443-640-1031
e-mail: pida@ksgroup.org
www.pida.org

Home // Manufacturer's Representatives Information // New Manufacturers Representatives Account Qualification Form

New Manufacturers Representatives Account Qualification Form

MAIN COMPANY INFORMATION

Company Name:

Mailing Address:

P.O. Box:

City:

State/Province:

Zip/Postal Code:

Country:

Company Phone:

Company Fax:

General Company E-mail:

Company Web Site:
(beginning with "http://")

KEY CONTACT INFORMATION

Enter the Key Contact for your company. The Key Contact is APPA's primary point of contact for any information, mailings, etc. that must be sent to your company.

First Name:

Last Name:

Title:

Phone:

Fax:

E-mail:

APPA/Global Pet Expo/PIDA do not make email information available to members or outside vendors. It is solely for the purpose of registration confirmation and communication of event information. A confirmation of this submission will be sent to the Key Contact's e-mail address.

ADDITIONAL COMPANY ATTENDEES

List the people within your company for whom you would like additional badges:

Email addresses for each registrant is required since their registration confirmation will contain a unique bar code that may be used to quickly print their badge on-site.

First Name	Last Name	Phone	Email (Required!)
1.)
2.)
3.)
4.)

Note that confirmation of this submission is only sent to the Key Contact. When approved, only those attendees that have valid e-mail addresses on record will receive e-mail confirmation of registration to attend Global Pet Expo.

ADDITIONAL REQUIRED INFORMATION

How did you hear about Global Pet Expo?

Has your company sent representatives to Global Pet Expo within the last 3 years?
NO YES, most recent year NOT SURE

List exhibiting APPA Members your company currently represents. Contact information required for verification. (Minimum two (2) required. No more than three necessary.)

Company:	Contact Name:	Phone or Email:
1.)
2.)
3.)

Registration will not be complete until qualification has been verified by the references provided above. Incomplete or incorrect information will delay processing.

Select the Category that best describes your company: (CHECK ONE)

Manufacturers Representative:

(ZZZ) APPA Member�
(ZZ) Non-APPA Member�

For more information about becoming an APPA Member Manufacturers Rep, go to www.americanpetproducts.org/membership.

Please enter any comments or questions regarding your registration:

I certify that the above information is correct as stated. I understand that if this information is incorrect, this application will be rejected. Please note this Registration Form will not be processed if this box is not checked.

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