CUSTOMER APPLICATION
(this is not an application for credit)

Company Name:

 Date:

Address:

P.O. Box:

City:

State:

Zip:

Owner, Officers, or Partners:

Contact Name:

Business Phone:

Fax:

Alternate Telephone:

E-mail:

Type of Business:

Number of Yrs.in Business:

Qualifications that make you eligible to purchase wholesale:
 
 

Trade Type:   Individual:                   Partnership:                    Corporation:

Taxable?

Yes?

No?

Tax or Federal I.D. #:

Nursery Dealer Stock # (required by the state agriculture dept.):

Trade References:

Name:

 Fax:

Name:

 Fax:

Name:

 Fax:

Have you read and understand the attached statement of policy?

Yes?

No?

Signature:
Did you initially hear about us from the Web? Yes: No:

Mail or fax your application to:

Acorn Farms
7679 Worthington Road
Galena, OH  43021
(614) 891-9348
FAX:  (614) 891-1002