Customer Name:

1. Information to be Released. By clicking the “Approve” box below, I authorize Agropec Trading, LLC (“Agropec”), which operates, to sell or otherwise release the information it has collected about me and my pet to Giant Eagle Company and its subsidiaries and affiliates (“Giant Eagle”). Such information may include, but is not limited to, my name, e-mail address, payment information, delivery address, telephone number, and pet related information, such as my pet’s name, gender, age, breed type, weight, dietary restrictions, order and prescription information, and veterinarian name and contact information.

2. Purpose. The purpose of this Authorization is to permit Agropec to release my information to Giant Eagle, so that Giant Eagle may use and further release my information for marketing purposes, including contacting me, and as otherwise set forth in the Giant Eagle privacy policy, which is available on

3. Your Rights. I understand that this Authorization is voluntary. I understand that Agropec will not condition treatment, payment, enrollment or eligibility for benefits upon execution of this Authorization. I may revoke this Authorization (and thereby block the further disclosure of my information to Giant Eagle) by contacting Agropec customer service at 888-320-1381. I understand that I can obtain a copy of this Authorization at any time by contacting Agropec customer service at 888-320-1381.

By signing this Authorization by clicking the “Approve” box below, I authorize the release of my information as outlined above.