New Customer Registration Form

Growing Wild, LLC

P.O Box 1481, Eagle, ID 83616, Ph: (970) 217-5183

growingwildgreenhouse@gmail.com , www.growingwildgreenhouse.com
Customer Details:

Confidential Account Application
Customer/Company Name *
Physical Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Mailing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
E-mail *
Contact Person *

First Name Last Name
Business Type *

Sole proprietorship Partnership Corportation LLC LLP Other
Federal EIN # or SSN# (if proprietorship): *
Idaho registered retailer, seller's permit number: *
Please upload a copy of your current Idaho Nursery License here: *

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I understand that by providing my contact information above, I consent to receive communications sent by, or on behalf of Growing Wild, LLC via mail, telephone, or email. I also understand that Growing Wild, LLC will not share the provided information with others.

All accounts are due and payable in full upon receipt of product.

Cash, checks, and Venmo (@growingwildgreenhouse) accepted. Credit card purchases will be charged a 3% processing fee. Unpaid balances will be charged interest at the rate of 1.5% per month (18% per year). Payment received on account will be credited to finance charges first, then to invoice in date order. If an account is delinquent (30+ days) further orders may be unavailable or subject to C.O.D. basis until the account is current.
I hearby certify the information provided her to be true to the best of my knowledge (sign below): *

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Customer Details: