Please print, sign, and fax this application to 305.477.5240.

PERSONAL INFORMATION

Firm Name:	*
Tax#:
Address:	*
City:	*
State:	*
Zip Code:	*
Country:	*
Phone:	*
Fax:
E-mail:	*
Emergency Contact:
Emergency Phone:

OWNERSHIP:

Company type (Please choose one):

Corporation	State of Incorporation
Partnership	Individual
Year Started / Incorporated:

OWNER(S)/PRINCIPAL(S):

Name:
Address:
City:
State:
Zip Code:
Country:
Phone:

BANK REFERENCE:

Name:
Address:
City:
State:
Zip Code:
Country:
Phone:
Fax:
Account No.:

TRADE REFERENCES/Cut Flower Suppliers:
(List Miami References First)

Reference 1:
Phone:
Fax:

Reference 2:
Phone:
Fax:

Reference 3:
Phone:
Fax:

Reference 4:
Phone:
Fax:

In consideration of the sale of merchandise by Seller to buyer, from time to time, and the extension of credit by Seller to Buyer with reguard to such sales, Guarantor does hereby guarantee to Seller full and promp payment of all indebtedess by buyer incurred for the merchandise furnished by seller, along with all service charges, collecton cost and attorney's fees where applicable.

Guarantor acknowleges that but for this guarantee, Seller would not extend such credit to Buyer. This guarantee shall remain in force until its revocation shall not affect any indebtedness of Buyer to Seller incured prior to reciept by Seller of written notice revocation.

Terms of sale are 30 days unless otherwise specified.
11/2% Per month will be charged to all overdue accounts.

I certify that all the information on this form is correct, and hereby agree to the above conditions of sale. If purchaser is a corporation or partnership, the undersigned personally and in his individual capacity, does hereby agree to fully guarantee prompt payment of all purchases and obligations. I further agree that if collection proceedings are necessary all charges for such proceedings will be payable by me and or the above named firm.

Dated this_____________day of_______________,

Guarantor:

______________________________________
SS #___________________________Individually

______________________________________
SS #___________________________Individually

* = Required fields

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