Please send or fax this form to: Horse Amour, PO Box 344 Castleton, VT 05735

Fax: 802-468-2151

P.O. Box 344
Castleton, VT 05735
(802) 468-2200

Horse Amour Peppermint Bit Wipes Dealer Application

Name of Store/Catalog:______________________________# years in business:______

Telephone#:____________________________Fax#:__________________________

Delivery address:_______________________________________________________

Billing address:_________________________________________________________

Federal ID#:__________________________State Tax Resale#:__________________

Name of purchaser/contact person:_________________________________________

web address:______________________________email:________________________

I certify that the above information is correct. I understand that overdue accounts will be assessed a $5.00 fee for every 30 days beyond the 30-day-net period.

Signature of Purchaser:________________________________Date:_______________

Approved accounts will be net 30 days. Thankyou.