Javascript is not currently enabled on your browser. If you can enable it, your input will be checked as you enter it (on most browsers, at least). You may find this helpful.

Greenleaf New Customer Application
Fields marked with an * are required.
Contact Information:
* Company Name: Required
*Contact Name: Required
*Business Street Address (shipping): Required
*City: Required
*State: Required
*Zip: Required
*Business Phone #: Required
Fax:  
*E-Mail address: Required
Website:  
Additional Information:
Agricultural License#:
(where applicable)		  
*State Resale Tax #: Required
Years in Business:  
Nearest Greenleaf Store: (within 75 miles, answer N/A if none)
  
Please email me future promotions and newsletters: (check for 'YES')  
I'd also like to register for Greenleaf's online ordering program.
What is Destination Fresh? (close the window to return here) 		 (check for 'YES')  
 
Billing Information for New Destination Fresh Account:
Credit Card billing address:
(if different than shipping address)
City:
State:
Zip:
Business Billing Phone #:
 
 
Note: Greenleaf is wholesale only and services the professional florist trade, not the general public. Membership to a wire service or state floral association helps ensure we sell to the trade. Please provide membership identification to any of these below:
Direct2florist:
FTD#:
Teleflora#:
SAF#:
State/Local Association #:
 

All of the responses above are true and correct:

Once your account is approved, a login will be be sent to the email address listed above.
Your privacy is extremely important to us: Read our PRIVACY POLICY.
Form: OIS 0125-07