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Breeder & Vet Account Application

Lone Star Pet Supply charges a $50 application fee to be refunded in the form of a credit with the first $500 minimum order.
Fee may be paid by credit card or money order.

Please fill in the form completely to expedite processing.
Your Name:
  We may wish to contact you for additional information about your application.
Please provide a valid email address below.
Your Email Address:
Vet/Kennel/Breeder Name:
Facility Address:
Facility City:
  State:   Zip:
  Mailing Address (if different from above)
Mailing Address:
Mailing City:
  State:   Zip:
   
Facility Main Phone #:
Fax #:
Sales Tax Permit Number: (if applicable)
  Copy of Sales Tax Permit Or Ag Exemption needs to be mailed or faxed to Lone Star.
Owner(s) First Name:
  Last Name:
Owner's Home Address:
Owner's City:
  State:   Zip:
Owner's Home Phone #:
Owner's Cell #:
Check Writer's First Name:
  Last Name:
Check Writer's Drivers Lic. #:
  State:   DOB:
  2nd Check Writer's Information (Optional)
2nd Check Writer's First Name:
  Last Name:
2nd Check Writer's Drivers Lic. #:
  State:   DOB:
1st Contact Name:
(Optional) 2nd Contact Name:
Contact Methods:
For Bird Breeders:
Types of Birds:   Number of breeding pairs:
For Kennels/Breeders:
Number of runs/kennels: 
List two pet industry references:
  Please include names
& phone numbers.
Facility Image:
  Please submit .jpg picture of kennel, aviary,
vet frontage (as applicable.)
P/O Required?:
Fax Invoices?:
Email Invoices?:
Fax Statements?:
Email Statements?: