The information supplied here is for the purpose of obtaining credit and is warranted to be true. In signing this application, I/We hereby authorize the firm to whom this application is made to investigate the references listed (including bank references) pertaining to my/our credit and financial responsibility.






Date: _____________


Firm Name: __________________________________        Corporation___ Partnership__ Sole Proprietorship__

Billing Address: ______________________________          Mailing Address: _____________________________
City & State: _________________________________         City & State: ________________________________

Phone No.___________________________________          Fax No.____________________________________

Year Business Established: ______________________         Under Present Ownership Since: ________________

Business Property Owned:  Yes____ No____                         Leased From: _______________________________

Federal ID #_________________________________           Resale Tax #________________________________

Owner/Officers Names             Title         Social Security #     Drivers License#    Home Address

________________________    _______   _______________  ________________  _________________________

________________________    _______   _______________  ________________  _________________________   

________________________    _______   _______________  ________________  _________________________


Trade References: List at least 3 Cut Flower Suppliers from whom purchases are made on a direct basis

Name                            Address                     City, State and Zip               Telephone No.         Fax No.

________________   _________________   _____________________    _______________   ________________

________________   _________________   _____________________    _______________   ________________
________________   _________________   _____________________    _______________   ________________

Bank Reference: Name ______________________   Account # _________________Checking __ Savings__
                             Address_____________________  City, State , Zip    _______________________________

                             Phone # ___________Fax #___________ Date Opened: __________Contact_____________


TERMS: NET 15 DAYS AFTER THE END OF MONTH and interest due and payable at 1.5% on all invoices over 30 days


PERSONAL GUARANTEE: In Consideration of any credit extended, I (we or either of us) will individually and/or jointly guarantee full and prompt payment of all indebtedness by (Firm Name) __________________

incurred for merchandise furnished by A. Perri Farms, Inc. plus service charges and collection costs, including Attorney’s Fees (Appellate if necessary) where applicable. This guarantee shall be continuing and the full agreement of guarantor(s) and is not subject to any oral conditions.