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Please send us the following information. If any fields do not apply, enter N/A. If any fields are the same as a previous one, put SAME.
thank you

URL Website Address
ie: www.yoursite.com:
2nd Web Site Address:
Street Address:
City, State, Zip:
Mailing Address:
City, State, Zip:
Telephone #:
Fax #:
Owner(s) Name:
Owner(s) Home Address:
City, State, Zip:
Owner(s) Home Telephone #:
Cell #:
Full Name of Credit Card Holder:
Credit Card Billing Address:
City, State, Zip:
Authorized Order Person Name:
Sales Tax Permit (State & number):
  Copy of Sales Tax Permit needs to be mailed or faxed to Aquarius Enterprises, Inc: 1-512-292-7957

Contact Information:
Contact Name:
Second Contact Name:
Contact E-Mail:

Aquarius Enterprises, Inc.
Our terms of sale are Credit Card Only. This is not an application for credit. This form and a copy of the Sales Tax Permit must be on file at our office before we can sell to you.
Type of Products You Want to Sell:
ie: dog, cat, cages
This will help us to grant the proper category discounts.