New Customer Information Form

(PLEASE NOTE: This is NOT an application for credit)

HELP US GET TO KNOW YOUR BUSINESS BETTER!

"*" indicates required fields

Business Name*

Date Business Established*

Today's Date*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Is your business address different than your mailing address?*

Business Address (If Different)*

Street Address Address Line 2 City State ZIP Code

Business Phone*

Fax

Cell Phone

Home Phone

Owner/Main Contact*

First Last

Email*

Should we charge your firm sales tax?*

Does your firm use P.O. numbers?*

WE REQUIRE YOUR SALES TAX NUMBER*

We can only set up the account without sales tax with a verifiable sales tax number. Sales tax numbers are 12 digits including the location number.

Do you wish to have limited signers?*

These person(s) listed below will be the only person(s) allowed to purchase under the account, all others will be turned down.*

First Name

Last Name

Will you be paying by check at the time of purchase?*

Will you be paying by credit card at the time of purchase?*

Would you like to keep a credit card on file?*

It is MANDATORY to provide Alameda Wholesale Nursery, Inc. with TWO OR MORE of the below documents showing your company as an established and recognized business within the GREEN INDUSTRY, in order to purchase wholesale items from us: It is also REQUIRED by the COLORADO COMMISSIONER to obtain a nursery registration that shall expire on December 31 of each year in order to transport nursery stock.

Trade Name Registration

Business Card

CLT Membership

ALCC Membership

Nursery Registration

Company Check/Credit Card

ASLA Membership

CNA Membership