AmpGarden LLC

Wholesale Dealer Account Application

Phone: +1 (321) 491-1688
Email address: sales@ampgarden.com
Address: 2300 Hardwood Marsh Rd. Clermont, Fl. 34711 #276

Company Name

Legal Entity

Business Address

Shipping Address (if different)

Phone:

Primary Contact Name/Title

AP/Accounting Contact Email

Federal Tax ID / EIN

Requested Terms:

Prepay

Net 15

Net 30

All Orders require the Authorized Signature of Buyer.

Dealer certifies the information provided is true and authorizes AmpGarden to verify trade/bank references for credit evaluation. Credit lines are granted based on accuracy and completeness of information provided and is subject to modification.

Authorized Signer (Dealer):

Name/Title:

Please sign in the yellow area.

Date:

Please sign in the yellow area.

Authorized Signer (Dealer):

Please sign in the yellow area.

*Note: Any Inquiries about purchase for wholesale are to be referred to AmpGarden management.