Trade Professional Application

Company Name *

Company Type * Wholesaler Retailer Florist Event Planner Other

Company address *

Fedeal Tax ID *

RESELLER LICENSE – Only Required in CA *

DUNS# *

Position/Title of person

Contact Phone Number *

Alternate Phone Number/Direct Line

Fax

Email *

Website

Estimated Annual Order Volume

Ship to address Commercial residential

Ship to contact

Address Line 1

Address Line 2

City