Download Customer information form

Customer Application – Web Version
(Please note that this is not an application for credit.)
Company name
Address
City
State
Owner
Email______________________________________
Phone
Mobile
Type of business
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Zip
(Tax Exempt document required **)
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Landscape Construction,
Maintenance or Architect
Interior Plant Design
Institution
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Garden Center (**)
Florist (**)
Builder/Contractor
Do you require Purchase Orders? Y / N
Church/School (**)
Other____________
Authorized Purchaser(s) employed by above mentioned company
Name
Cell Phone
Position:
Email
Name
Cell Phone
Position:
Email
Name
Cell Phone
Position”
Email
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Terms and Conditions
All sales are final. We make no warranty or guarantee, expressed or implied, as to the description, productiveness or health on the
products we sell. We will not be responsible for the results of the plant material in the landscape. Acceptance of plant material at the time
of purchase is considered acknowledgement of this policy.
Payment
We accept cash, Master Card, Visa, American Express and Discover. Business Checks will be accepted only with the company
name imprinted on the front of the check; no third party or postdated checks will be accepted; we reserve the right to not accept a check.
Credit Card Payment
I have read and fully understand the terms and conditions as outlined above. Should I opt to pay by credit card,
I acknowledge I am bound by these terms of sale in the event that I claim a dispute with my credit card company.
All terms and conditions are subject to change.
I certify all information provided above to be correct. I fully understand and agree to comply with
the Terms and Conditions on this form.
Signature
_______ Entered into Website
For office use:
Customer number ____________________________
Date approved ______________________________
Print Name & Title
Date
Approved by_______________________________
Hicks Nurseries Commercial Sales is a division of Hicks Nurseries, Inc.