Store Name: Store Address: Store Phone: Store Owner and Manager Information: Name Title Cell Email Include on email contact (YES or NO) NoYes NoYes NoYes NoYes NoYes NoYes Who is our main contact on decision making? Do you have a Contracted Vet? ---NoYes Contracted Vet Information: If you have more than 3 vet locations, please submit additional location details on a separate sheet Business Name Address Phone Number Email Vet Name Vet Phone Number (if different than business) Office Manager Name (If applicable) Office Manager Number (if different than business) Business Name Address Phone Number Email Vet Name Vet Phone Number (if different than business) Office Manager Name (If applicable) Office Manager Number (if different than business) Business Name Address Phone Number Email Vet Name Vet Phone Number (if different than business) Office Manager Name (If applicable) Office Manager Number (if different than business) If you do not have a contracted vet, please answer additional questions below: Do you have a vet that completes animal check ins at the store? ---NoYes If YES, please provide the following details: Vet Name: Frequency of Store Visits: If No, please note that your account manager will be discussing this in more detail Puppy Warranty and Kit Information: How many days does a customer have to go to veterinarian to validate the warranty? If your warranty requires customers to use your contracted vet, are there any exceptions? ---NoYes Do you offer any puppy for lifetime program? ---NoYes Do you provide a kit with the purchase of puppy? ---NoYes PLEASE INCLUDE ALL WARRANTIES, KIT DETAILS AND EXAMPLE PURCHASE RECEIPT WITH SUBMISSION OF THIS PAPERWORK Does your store have an attorney? ---YesNo Legal Counsel Details: Attorney Name Attorney Phone Number Attorney Email Insurance Details: Insurance Business Name Contact Name Contact Phone Number Contact Email Please note that per the agreement, store must have Solutions.pet listed as an additional insured (Please refer to agreement for additional details) PLEASE INCLUDE PROOF OF INSURANCE DESIGNATION WITH SUBMISSION OF THIS PAPERWORK Additional Pet Information: Do you sell other animals besides puppies? ---NoYes If Yes, please list animals below: Animal Type Do you include warranty with purchase Do you provide any additional products or kit with purchase YesNo NoYes YesNo NoYes YesNo NoYes YesNo NoYes YesNo NoYes PLEASE INCLUDE ALL WARRANTIES, KIT DETAILS AND EXAMPLE PURCHASE RECEIPT WITH SUBMISSION OF THIS PAPERWORK Where can we send a confirmation email that this form has been completed? Δ anthonyContact Form06.17.2020