Commercial Customer Information Form

Commercial Customer Information

New Commercial Customer Form

Firm Name:(Required)

Office Address:(Required)

Street Address City State / Province / Region ZIP / Postal Code

Mailing Address is different

Yes

Mailing Address (If different from above)

Street Address City State / Province / Region ZIP / Postal Code

Main Phone(Required)

Fax

Main Email(Required)

FED I.D.#

Website

Type of Business(Required)

Nursery/Contractor License #:

Legal Status:

Proprietorship

Partnership

Incorporated

Incorporated In (State):

Since:

Year Established

At Present Location since:

Previous Location:

Officer(s)/Owner(s) Name:

First Last

Phone

Officer(s)/Owner(s) Name:

First Last

Phone

Officer(s)/Owner(s) Name:

Resale Card File

Accepted file types: pdf, jpg, png, Max. file size: 2 MB.

Person submitting form:(Required)

Phone

CAPTCHA

Comments

This field is for validation purposes and should be left unchanged.