Wholesale Membership Application
Applicant: By filling out and signing this application, you are applying for a Patuxent Nursery Corporate Wholesale Account. By completing this online application, you agree that all information is true and complete, and that Patuxent Nursery is responsible for determining membership eligibility.

You do not need to apply for credit to be a wholesale member, but you do need to be a wholesale member to have credit. Visit the Patuxent Nursery website to complete the Cooperate Credit Application.
Email address *
Customer # *
Business Name *
Phone Number *
ex. 123-456-7890
Fax Number
ex. 123-456-7890
Street Address *
City *
State *
Zip Code *
D/B/A
Federal Tax ID # *
Type of Business *
Date Established *
MM
/
DD
/
YYYY
How Long in Business *
ex. 0 years, 4 months
No. of Employees *
Est. Annual Sales *
Sales Area *
Does your State, County, or City require a License? *
If Yes, License #
Ownership *
Required
Principal #1 *
Name, Title
Principal #2
Name, Title
Before Submitting...
Please double-check the information you've entered above and ensure it is accurate. By submitting this form, you agree that all information is true and complete, and that Patuxent Nursery is responsible for determining membership eligibility.

Please visit the Patuxent Nursery website to complete the separate Cooperate Credit Application.
A copy of your responses will be emailed to the address you provided.
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