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INFORMATION MUST BE COMPLETED IN FULL.
ALL INFORMATION WILL BE HELD IN STRICTEST CONFIDENCE.

If you prefer, you may print out this form and fax it to (805) 772-9710, or call 805-772-1320 to apply over the phone.
Contact name   Name of business
Business address   Years in business
Business address 2  
City      
State           
Zip   Phone
Country   Fax
Ship address   email
Ship City      
Ship State        
Shipping Zip      
Ship Country      
Legal entity Individual Partership Corporation LLC LLP
Incorporation date   State of incorporation
Federal tax id OR   SSN
      and name
Business type Wholesale Retail
  Grower Distributor Supermarket Shipper Other
CA resale tax number   Wholesale licence number
         
Annual gross floral sales   Number of stores
         
 
   
YOUR ACCOUNT    |    GUARANTEE    |    RETURNS     |    PRIVACY

Barons Orchids
805-772-1320    fax:805-772-9710
465 Harbor St, Morro Bay, CA 93442
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