Header2.jpg

Join Now!

If you'd like to join the Veterinary Purchasing Group, please fill out the form below and a representative will contact you shortly. Thank You!

Contact

Name of Practice*
Address
 
City
State
Zip
Website URL
First Name of Primary Contact*
Last Name of Primary Contact*
Business Phone*
Cell Phone
Best time of day to call
Email*
Hospital Type

Staff

Number of DVMs
(Full-time or equivalent)
Total Number of Employees
Years in Business

Revenue

Estimated Current Year $
Estimated Prior Year $

Vendors

Preferred Drug/Supplies Vendor
Preferred Outside/Inhouse Lab Vendor
Preferred Vaccines Brand

Facility

Building Size
Year Built
Square Footage
Number of Exam Rooms
Ownership
(please indicate the name of each current owner and the percentage of the practice that each person owns)

Referral

Referral Source

Billing

Become a VPG member for only $65 per month.

Fill billing from contact.
First Name*
Last Name*
Address*
Address line 2
City*
State*
Zip*
Phone
Email*

Credit Card

Credit Card No.*
CID No.*
Your Security Code is either a 3-digit number located on the back of your Visa, Mastercard or Discover, or a 4-digit number located on the front of your American Express.
Expiration Date* /