Dealer Application

Become a Whitfield's Dealer, please provide as much information as

possible below and click submit to send your application for consideration.

Your Name (Contact Person):

Company Name:

Street Address (1st line):

Street Address(2nd line):

City:

State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY    Zip Code:

Business Phone:

Business Fax:

Home Phone (optional):

Email Address:

Type of Operation:   Dealer     Livestock Producer 

                         Elevator   Feed Store & Supply/Retail

                                  Other (please specify)

Current Feed Brands/Products in Use:

Products of Interest:  Golden Flo®  Show Feeds  Beef

                       Swine Sheep Horse Custom

               Other (please specify)

Best time to contact you:

Enter any comments in the space provided below: