New Customer Application Brehob Nurseries, LLC has elected to sell only to landscape professionals, garden centers & municipalities. Please enable JavaScript in your browser to complete this form.Full Business Name: *Address (street address): *Street AddressAddress (city, state, zipcode): *City, State, Zip CodePhone Number: *Office Phone NumberCell Phone Number: *Email: *Years in Business: *Federal ID Number: *Nursery Dealers License: *Requirement for any person who grows or buys nursery stock for the purpose of reselling or reshipping that stock in Indiana. This can be found on the Indiana DNR's website at https://www.in.gov/dnrIndiana Retail Merchants Certificate:Required for Retailers or Re-wholesalers (can be found on State of Indiana's website)PO or Job Name Required? *YesNoTax Exempt? *YesNoIf yes, an ST-105 form MUST be on file before you will be considered tax exempt. The form can be mailed or emailed to the Distribution CenterType of Business: *LandscaperRewholesaleRetail Garden CenterGovernment/CityGolf Course/ CemeteryBuilder/DeveloperSchool/HospitalOtherIf Other please explain: Types of Services Offered: (choose all that apply) *LandscapingLandscape DesignLandscape LightingMaintenanceHardscapingSnow Removal/Salting Owner of Company: *Owner of CompanyAuthorized Buyer (only people on your approved list will be allowed to purchase): *Name, Position, Cell phone Authorized Buyer:Name, Position, Cell PhoneAuthorized Buyer:Name, Position, Cell PhoneTrade References: (names of businesses who can substantiate your business) *(Name, Phone Number, Address) *No Credit information will be askedTrade References: * (Name, Phone Number, Address) *No Credit information will be askedTrade References: * (Name, Phone Number, Address) *No Credit information will be askedNameSubmit *Credit Application for Terms is available upon request. Please contact one of our Distribution Centers.