Wholesale Application Form Wholesale Customer Section Company Information * Owner's Name Contact Name * Contact Last Name * Email Address * Phone Number * Primary Alt. Phone Secondary Website/URL Business Description Yrs in Business Yrs in Business Company Category Floral Green House Farm/Farm Market Manufacturing Gift Cart Other Company Category Type of Business Corporation Partnership Sole Proprietorship Other Type of Business Tax ID # * Tax ID # Driver's License # * Driver's License # Section Billing Address * Billing Address 2 Billing City * City* BIlling State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY State* BIlling Zip/Postal Zip/Postal* Shipping Address * Shipping Address 2 Shipping City * City* Shipping State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY State* Shipping Zip/Postal Zip/Postal* CAPTCHA Email Email If you are human, leave this field blank. FOR APPLICATIONS PLACED ON THE INTERNET:By clicking on the “Submit” Button, you agree to the “Terms and Conditions” of our website and company policies and you are legally stating that the County or State Vendor’s License number that you enter is valid and is assigned to you/your company. Submit Δ