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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 Zip (Tax Exempt document required **) Landscape Construction, Maintenance or Architect Interior Plant Design Institution 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 Please Check Box if you do not want to receive our communications regarding specials and availabilities. 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.