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New Customer Registration

Company name*

First name*

Last name*

Physical address

Country/Region*

Address*

Address - line 2*

City*

Zip / Postal code*

Mailing address (if different)

Mailing address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Number of years in business*

Basic Contact Info

Office email

Office phone

Cell phone

Ordering Contact Info

Ordering contact name (if different)

Ordering email (if different)

Ordering phone (if different)

A/P Contact Info

Who should receive invoices and statements?*

Same as main contact

Accounts payable contact

A/P contact first and last name

Invoicing email

A/P phone

State where incorporated

Federal ID number*

Pick one:*

Corporation

Partnership

Sole Proprietor

LLC

Other

Will your purchases be sales tax exempt?*

Yes

Sales tax exempt form

If you are not in Ohio, Ohio allows you to sign its form in order to claim exemption for purchases from Brown's. Please ask and we will provide you the form if you do not have one. If you are an out of state company, we also require your state's Sales Tax Exemption form to be on file. All forms must be filled in completely to be considered valid.

Nursery License

*We require a copy of your Nursery License to be on file with us to receive our Wholesale Pricing. For more info view our wholesale page on our website.

Name of corporate officers or owners*

Address of owners

Phone number of owners

Notes or information (additional phone numbers, or ordering contacts, etc)

Printed Name*

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Signature*

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Date*

Month

Day

Year