Account Application

Account Application Form

1Account

2Address

3Ownership

4Contacts

5Business Info

6Lists

7References

8Uploads

9Confirmation

Address Information
Facility Address*
Address Line 1 Address Line 2 City State ZIP Code
Facility Address*
Address Line 1 Address Line 2 City Province Postal Code
Facility Address*
Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Phone*
FAX
FAX
Billing Address*
- Same As Facility
- Different
Billing Address*
Address Line 1 Address Line 2 City State ZIP Code
Billing Address*
Address Line 1 Address Line 2 City Province Postal Code
Billing Address*
Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Phone*
FAX
FAX
Notes

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Ownership Information
Business Structure*
Name*
First Last
Title
Home Address
Address Line 1 Address Line 2 City State ZIP Code
Home Address
Address Line 1 Address Line 2 City Province Postal Code
Home Address
Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone*
Cell Phone*
Home Phone
Home Phone
Email*
How many additional owners would you like to list?
Owner Two
Name
First Last
Title
Home Address
Address Line 1 Address Line 2 City State ZIP Code
Home Address
Address Line 1 Address Line 2 City Province Postal Code
Home Address
Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone
Cell Phone
Home Phone
Home Phone
Email
Owner Three
Name
First Last
Title
Home Address
Address Line 1 Address Line 2 City State ZIP Code
Home Address
Address Line 1 Address Line 2 City Province Postal Code
Home Address
Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone
Cell Phone
Home Phone
Home Phone
Email
Owner Four
Name
First Last
Title
Home Address
Address Line 1 Address Line 2 City State ZIP Code
Home Address
Address Line 1 Address Line 2 City Province Postal Code
Home Address
Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone
Cell Phone
Home Phone
Home Phone
Email
Owner Five
Name
First Last
Title
Home Address
Address Line 1 Address Line 2 City State ZIP Code
Home Address
Address Line 1 Address Line 2 City Province Postal Code
Home Address
Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone
Cell Phone
Home Phone
Home Phone
Email
Owner Six
Name
First Last
Title
Home Address
Address Line 1 Address Line 2 City State ZIP Code
Home Address
Address Line 1 Address Line 2 City Province Postal Code
Home Address
Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone
Cell Phone
Home Phone
Home Phone
Email
Notes

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File Uploads
In order to ensure that account applicants are operating a legitimate business we require the following documents and images.

Allowable file extensions are .jpg, .gif, .png, .bmp, .pdf, .doc, .docx
Files are limited to 8mb in size.
Business Documents
Please upload copies of the business documents that you typically provide to vendors. Depending on your region these may include your Business License, Sales Tax Exemption Document, Tax ID, FEIN and so on....
Business documents*
Drop files here or

Accepted file types: jpg, gif, png, pdf, bmp, doc, docx, Max. file size: 50 MB, Max. files: 6.
Business Photos
Please provide us with photos of your business. Exterior photos are required and we prefer to see photos with signage and posted business hours. Interior photos are encouraged to speed up the approval process but are not required.

We understand that this may be an inconvenience but we hope that you will appreciate our effort to ensure that only qualified dealers have access to ORA products.
Exterior Photos of Business (up to three)*
Drop files here or

Accepted file types: jpg, gif, png, pdf, bmp, doc, docx, Max. file size: 50 MB, Max. files: 3.
Photos showing exterior signage and posted business hours preferred.
Exterior Photos of Business (up to three)
Drop files here or

Accepted file types: jpg, gif, png, pdf, bmp, doc, docx, Max. file size: 50 MB, Max. files: 3.
Photos showing exterior signage and posted business hours preferred. Optional but recommended for account approval.
Inside store photo (up to three)

Drop files here or

Accepted file types: jpg, gif, png, pdf, bmp, doc, docx, Max. file size: 50 MB, Max. files: 3.

Optional but recommended for account approval.
Industry Supplier Invoices
Please provide us with copies of invoices from three Aquarium Industry suppliers. You may black out prices but not quantity or address information.

These fields are optional but encouraged for speedy account approval.
Industry supplier invoice #1 (one per field)

Drop files here or

Accepted file types: jpg, gif, png, pdf, bmp, doc, docx, Max. file size: 50 MB, Max. files: 1.
Industry supplier invoice #2 (one per field)

Drop files here or

Accepted file types: jpg, gif, png, pdf, bmp, doc, docx, Max. file size: 50 MB, Max. files: 1.
Industry supplier invoice #3 (one per field)

Drop files here or

Accepted file types: jpg, gif, png, pdf, bmp, doc, docx, Max. file size: 50 MB, Max. files: 1.
Notes
Public Aquariums & Institutions
Do you require any special documentation from us? Please describe below.
If you have any forms that ORA will need to fill out please upload them here.

Drop files here or

Accepted file types: jpg, gif, png, pdf, bmp, doc, docx, Max. file size: 50 MB, Max. files: 5.

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{all_fields}
Confirmation
Date*
MM slash DD slash YYYY

Signature*

Notes
Consent*
I consent to my submitted data being collected and stored.
Captcha

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First Name	Last Name	Job Title	Email	Cell Phone

Account Application

Account Application Form

Thank you for your interest in becoming an ORA dealer. Please complete the account application below. Required fields are marked with a green asterisk.*

In order to complete our retailer account application you will be asked for the following information as you proceed through this form:

Multi-Unit Retailers, please fill out this application for one of your locations. We will contact you to discuss the details of each of your locations after the application has been submitted.

Address Information

Ownership Information

Owner Two

Owner Three

Owner Four

Owner Five

Owner Six

Alternate Contacts

Business Information

Price Lists

Online Ordering

Trade References

File Uploads

Business Documents

Business Photos

Industry Supplier Invoices

Public Aquariums & Institutions

Confirmation

Sign up and let us know what you're interested in

Description	Number