Wholesale Account Application

Thank you for your interest in becoming a Greens World wholesale customer. Please complete the application form below. A W-9 Form will be sent upon request.

* : required

Organization of Business:*

Legal Name of Business:*Trade Name or DBA:

State of Incorporation:*Date of Incorporation:*

Federal EIN# or SSN#:*Resale #:

Briefly describe your business:

Owner Name:*Owner Phone:*

Owner Email:*

Buyer Name:*Buyer Phone:*

Buyer Email:*

Ship To Address:*Ship To City:*

Ship To State:*Ship To Zip:*

Is your billing address the same as shipping?* Yes No

Accounts Payable Contact:*Accounts Payable Email:*

Accounts Payable Phone:*Accounts Payable Fax:

Trade Reference Name:Trade Reference Phone:

Please upload your completed tax exemption certificates if applicable and/or your professional license:

Please complete the visual confirmation*

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