Koi Care Kennel, LLC - Focused on Koi Health

New Wholesale Account Request Form

This form is for NEW customers who have not placed orders with us in the past.

If you Have the Old Site Password then you will want to login here.

Once you completed this simple form, your account will be submitted for approval. You will be notified when it has been activated.

Be sure you keep track of your username and password in a secure location.

Every time you log in the future, you will be able to simply "click and go" to place your order. The only additional information you may want to add, are special requests or instructions.

We trust you will enjoy the new upgrades, and by all means we welcome your feedback.

Name:
Company:
Tax Id: *(California Only)
Address:

City:
State:
Zip Code:
Phone:
FAX:
Email:
Choose Your UserId:
Choose Your Password:
Password (to confirm):