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Vendor PIN Request Form
New Vendor Information Request Form
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In order to ensure that we are able to supply retailers with the best quality fish possible, we hold all of our vendors to the highest possible standards. If you are a breeder or fish farmer wanting to offer your fish through Segrest Farms, please fill out the form below.
Required fields -
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Business Name:
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Contact Name
*
:
Address
*
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City/State/Zip
*
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Primary Phone Number
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Cell Phone Number
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Fax Number
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Email Address
*
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Web site
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Relevant Permit Type(s) and Number(s):
Professional Reference 1:
Name:
Email:
Phone:
Professional Reference 2:
Name:
Email:
Phone:
Professional Reference 3:
Name:
Email:
Phone:
Industry Association Memberships
(check all organizations to which you are a member)
*Segrest Farms gives priority to companies who support the entire
industry through
memberships in professional associations
Florida Tropical Fish Farmers Association:
National Aquaculture Association:
Pet Leadership Council:
Pet Industry Joint Advisory Council:
Ornamental Fish Industries:
Other:
International Account Number:
International Swift Code:
Comments:
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