Fresh Flower Growers - Distributors - Marketers 1500 NW 95th Avenue, Doral, FL 3372 Telephone. 305-594-3048 Fax. 305-594-3049 Toll Free. 866-RIO-ROSE (746-7673)
New Customer Application General Information Company Name: ________________________________________________________________________________ Doing business as: ______________________________________________A/K/A: ___________________________ Shipping address: _______________________________________________________________________________ Mailing address: _________________________________________________________________________________ Phone: (____) _________________________________ Fax: (____) _______________________________________ Email Address: ______________________________________ Website:____________________________________ How long at this location? ________________________ Own: _______ Rent: _______ Landlord/Mortgage Holder: ________________________________________________________________________ Address: _______________________________________________________________________________________ Accounts Payable Contact: _________________________________________ Phone: (____)___________________ Authorized Buyers: ________________________________________________ Phone: (____)___________________ Credit Extension Requested: _______________________________________________________________________ Are you interested in Equiconnect access for online purchasing 24/7?
Yes
No
Business Information Date Business Started: _______ Company Structure:_____Corporation ____LLC ____Partnership ____Proprietorship Name of other business within this trade? __________________________________Location____________________ Federal Identification Number: __________________________________Sales Tax Number_____________________ Date of Incorporation: ____________________ State of Incorporation: ______________________________________ Have you ever filed for bankruptcy? :
Yes
No
If so, under what Name, Chapter, and Year ____________________________________________________________
Banking Information Name of bank: __________________________________________________________________________________ Address: _______________________________________________________________________________________ Person to contact: ________________________________ Phone (____) _____________Fax (____) _____________ Account Number: ____________________________________________ Date account opened: _________________ 1