Customer Application Form

33%

Thank you for your interest in KindredBio. To place an order with us, an account for your company must be established in advance. To set up an account, please complete this electronic application. If you have a question about your application or need assistance with an urgent request, please contact KindredBio Customer Service at CustomerService@KindredBio.com or call 1-888-608-2542.

Fields marked with an asterisk (*) are required.
First tell us about your business
Practice Name*
Type of Practice
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business Phone Number*
Business Email Address
Business Fax Number
Accounts Receivable contact
First Last
Preferred Method of Contact
Number of DVMs at the Practice
Buying Group

Next, tell us about you
Name*
Prefix First Last Suffix
Personal Phone Number*
Personal Fax Number
Personal Email Address*
Veterinary License Number*
Veterinary License Number Expiration Date*
DEA Number
DEA Number Expiration Date
Does your business have a designated order contact or office manager?*
- Yes
- No

US-Corp-1800028 V2