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Credit Application Form

Please Provide Details Below
 

Nursery/Greenhouse Name *

Tax #

Owner’s Name *

Address *

City *

State *

Zip *

Country *

Phone
Fax
Email *
Website
How Long In Business
Type of Business Sole Proprietor Partnership Corporation Other
Premises Status Own Lease Rent
Years at Location
 
Names of officers and/or partners:
 
Name
Address
Title
Phone
 
Name
Address
Title
Phone
 
Name
Address
Title
Phone
 
Trade References (Please include at least 2 Plant Suppliers)
 
Name
Address
City
State
Zip
Country
Phone
Fax
Email
 
Name
Address
City
State
Zip
Country
Phone
Fax
Email
 
Name
Address
City
State
Zip
Country
Phone
Fax
Email
 
Name
Address
City
State
Zip
Country
Phone
Fax
Email
   

By checking this box, and as part of this application for credit submitted on-line, you grant permission to obtain credit references from creditors listed above. You further agree to pay a service charge of 1.5% per month (or legal rate) on invoices not paid according to terms