New Account Information Form
Company Name
*
Legal Business Name
Buyer
First Name
Last Name
Title
Buyer's role within the company
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Tax ID #
Business Website
Company Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is Billing Address same with the company address?
Yes
No
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Nursery Stock Dealers Licence
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Where did you hear about Great Lakes?
Contacts/ anyone allowed to pick up orders, place orders, or be onsite during a delivery:
Would you like to receive emails from us? (Select all that apply)
*
Availability
Product Features
Events & News
I would not like to receive emails from GLLS Marketing
Which email(s) would you like us to use?
Would you like to sign up for text messages from us? Get last minute event reminders, hear about sales, and product highlights.
Yes
No
Which Phone Number(s) would you like to receive the texts?
Date
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Title
*
Role in the company
Signature
*
Continue
Continue
Should be Empty: