New Customer Application

For an account, please complete this application and mail or email required forms (W-9, ST-105, etc.) to Southern View Nursery, Inc. By submitting this application you acknowledge that you understand and agree to the Terms & Conditions.

Full Business Name

Owner's Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Office Phone Number

(###)

###

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Cell Phone Number

(###)

###

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Number of Years in Business

Federal ID Number

Nursery Dealer License Number

Required for any person who grows or buys nursery stock for the purpose of reselling or reshipping that stock in Indiana. The form can be found on the Indiana DNR website at: https://www.in.gov/dnr/entomology/nursery-growers-and-dealers/

Indiana Retail Merchant Certificate

Required for Retailers or Re-wholesalers (can be found on State of Indiana's website).

Type of Business

Other (please explain)

Tax Exempt?

If yes, form ST-105 MUST be on file before you will be considered tax exempt. The form can be mailed or emailed to Southern View Nursery, Inc.

Yes

Authorized Buyer #1

Only people on your approved list will be allowed to purchase.

First Name

Last Name

Authorized Buyer #2

First Name

Last Name

Authorized Buyer #3

First Name

Last Name

Acknowledgment

I have read and understand the terms & conditions.