JOHNSON FARMS CREDIT APPLICATION
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HOME
WHOLESALE NURSERY
ABOUT US
HISTORY
STAFF BIO'S
AVAILABILITY
SOD
FORMS
FORMS
GUIDES
PHOTO / VIDEO
SHIPPING QUOTE
ACCOUNT NUMBER
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Address
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PRINT NAME AND DATE
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Address
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REFERENCE 2:
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CONTACT PERSON, PHONE & FAX NUMBER
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PERSONAL GUARANTY
ARE YOUR PURCHASES TAXABLE
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YES
NO
Driver License #
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AUTHORIZED SIGNERS ON ACCOUNT:
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STATE OF INCORPORATION
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BANK REFERENCES
CORPORATION SIGNATURE AND DATE
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PHONE / CELL:
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CREDIT RELEASE OF AUTHORIZATION
Thank you for contacting us! If needed, you will hear back within 48-72 hours.
PHONE / CELL:
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SPECIFY ACCOUNT TYPE AND ACCOUNT NUMBER
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ACCOUNT NUMBER
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REFERENCE 1:
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Address
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FAX:
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FORM OF COMPANY
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INDIVIDUAL
PARTNERSHIP
CORPORATION
LLC
BUSINESS NAME:
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NAME OF OWNERS / OFFICERS
Address
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Social Number / Driver License
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Shipping Address
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NAME: 2
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INDIVIDUAL SIGNATURE AND DATE
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TAX EXEMPT# (WILL BE REQUIRED TO SUBMIT SEPERATLY)
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REFERENCE 2:
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MINI MIRANDA WARNING
REFERENCE 4:
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INDIVIDUAL SIGNATURE AND DATE
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CORPORATION SIGNATURE AND DATE
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Address
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SIGNATURE AND DATE
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HAVE YOU EVER FILED BANKRUPTCY?
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YES
NO
YEARS IN BUSINESS
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NAME: 1
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ACCOUNT NUMBER
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BUSINESS NAME:
CORPORATION SIGNATURE AND DATE
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REFERENCE 1:
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CONTACT PERSON, PHONE & FAX NUMBER
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DO YOU OPERATE UNDER A dba ( IF SO, STATE THE NAME)
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Thank you for contacting us! If needed, you will hear back within 48-72 hours.
PHONE / CELL:
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IF YES, UNDER WHAT NAME?
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NAME: 3
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CONTACT PERSON, PHONE & FAX NUMBER
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Address
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PAYMENT TERMS AND GUARANTY
TRADE REFERENCES - MUST PROVIDE FOUR (4) NURSERY RELATED ACCOUNTS WITH 30 DAY TERMS
ACCOUNTS PAYABLE PERSON AND PHONE#
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BUSINESS TAX ID OR DRIVERS LICENSE
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CONTACT PERSON, PHONE & FAX NUMBER
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Thank you for contacting us! If needed, you will hear back within 48-72 hours.
Address
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REFERENCE 3:
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PRINT NAME AND DATE
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Address
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DO YOU HAVE JUDGMENTS?
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YES
NO
SPECIFY ACCOUNT TYPE AND ACCOUNT NUMBER
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BUSINESS NAME:
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CONTACT PERSON, PHONE & FAX NUMBER
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