CUSTOMER VERIFICATION/TAX FORM


Please fill out the New Customer Form below. When it is complete, hit the Submit button at the bottom of the form

Street Address
Business Name
City
State
Zip
Billing Address
(If Different than Above)
City
State
Zip
Phone
Cell
Fax
Buyer is in the business of
E-mail Address
Reseller Permit
Valid From
to
Reason
List of Authorized Buyers
(First & Last, separate
individuals with comma)
Owner / Contact Name
I want to be included on the Vibrant Plants e-mail list to receive occasional availabilities and hotsheets. If you don’t wish to be included on our e-mail list simply un-check the above box.
UBI Number
Non Taxable
Taxable
Exempt
Yes!