Credit Application Date___________________
Please print and complete this form.
Mail to Q&Z Nursery. Download PDF format(requires Adobe Acrobat)
Firm Name
Phone ( )
Billing Address
FAX ( )
City
State
Zip
Shipping Address
City
State
Zip
Pay Sales Tax: __Yes __No
Tax Number:
In Business Since:
Type of Organization: __Corporation __Partnership __Individual
Name & Title of Principals:
Bank Reference
Bank Name
Acct No.
Address
Contact
City
Phone ( )
State
Zip
FAX ( )
Trade Reference
Firm Name
Contact
Address
Phone ( )
City
FAX ( )
State
Zip
Trade Reference
Firm Name
Contact
Address
Phone ( )
City
FAX ( )
State
Zip
Trade Reference
Firm Name
Contact
Address
Phone ( )
City
FAX ( )
State
Zip
Applicant's signature attests financial responsibility, ability and willingness to pay invoices in accordance with
terms offered. The above information is for the purpose of obtaining credit and is warranted to be true. I/we hereby authorize Q&Z Nursery, Inc. to investigate references listed pertaining to my/our credit and financial responsibility.
A service charge of 2% per month (annual rate 24%) will be charged on overdue invoices.