Wholesale
Credit Card Authorization Form

Complete this authorization for your KOIPET wholesale account. This form does not collect full credit card numbers or security codes. Card registration must be completed through an approved secure payment process.

01 – BUSINESS INFORMATION & BILLING

← Back

Thank you for your response. ✨

Legal Business Name

Store / DBA Name

Authorized Representative

Title

Billing Email

Phone

Billing Street Address

Billing City

Billing State

Billing ZIP Code

Card Brand (optional)

Card Last Four Digits (optional; NEVER enter full card number)

Authorization Scope(required)

Card on File Only - each charge separately authorized

Wholesale Invoice Payments - authorized invoices only

Credit Card Fee Disclosure

Payment Authorization

Electronic Signature - Type Full Legal Name

Signature Date (MM/DD/YYYY)

KOIPET Wholesale · Koi Pet Inc. · 2020 129th St, College Point, NY 11356
Questions: info@koipet.com · Never submit a full card number or CVC/CVV.

WholesaleCredit Card Authorization Form

Thank you for your response. ✨

Wholesale
Credit Card Authorization Form