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704.596.3220
or 800.438.0444
dredman@baucomsnursery.com
Monday - Friday 8:00am - 4:00pm
Saturday 8:00am - 11:30am
Sunday Closed
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10020 John Russell Road, Charlotte, NC 28213
Baucom's Nursery
Wholesale Nursery in Charlotte NC
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Credit App
In-House Credit Application
We offer in-house credit to qualified wholesale nurseries.
If you would like to apply, please complete the application below:
Step
1
of
10
10%
Company Information
Company Name
*
Date
*
MM slash DD slash YYYY
Billing Address
*
Street Address
Address Line 2
City
Alabama
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Ohio
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Pennsylvania
Puerto Rico
Rhode Island
South Carolina
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Tennessee
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Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Shipping Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
FAX
*
Sales Tax #
*
Please Attach Copy of Exemption Certificate
Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 128 MB.
Type of Business
*
Foliage
Landscape
Farm
How long under present ownership?
*
What is the form of business ownership?
*
Corporation
Partnership
Limited Partnership
Proprietorship
Principal Owners or Stockholders of Business
Please provide all applicable
Principal Owner or Stockholder 1
*
First
Last
Email
Enter Email
Confirm Email
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Cell Phone
*
Office Phone
*
Principal Owner or Stockholder 2
First
Last
Email
Enter Email
Confirm Email
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Cell Phone
Office Phone
The business is operated on real property which is:
*
Leased
Owned by the business
Who is the owner/lessor of said property?
Real property where the business is located
*
Company Financial Information
Approximate Gross Annual Sales:
*
Approximate Net Profit:
*
Approximate Net Worth:
*
Number of Employees:
*
Sources of financing: (click all that apply)
*
To select multiple choices, hold down the CNTL key while selecting.
SAVINGS & LOAN
PRODUCTION CREDIT ON FEDERAL LAND BANK
BANK
SBA
OTHER COMMERCIAL LENDER
INSURANCE COMPANY
OTHER
Name of Institution Providing the Financing
*
Trade Credit References
(Must Provide At Least Four)
Trade Credit Reference 1
*
Credit Amount 1
*
Address 1
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
FAX 1
*
Email 1
*
Trade Credit Reference 2
*
Credit Amount 2
*
Address 2
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
FAX 2
*
Email 2
*
Trade Credit Reference 3
*
Credit Amount 3
*
Address 3
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
FAX 3
*
Email 3
*
Trade Credit Reference 4
*
Credit Amount 4
*
Address 4
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
FAX 4
*
Email 4
*
Bank Reference
Bank Name 1
*
Account Type
*
Checking
Savings
Account Number
*
Bank Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Bank Name 2
*
Account Type
*
Checking
Savings
Account Number
*
Bank Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Credit Line
Total Amount of Credit Requested
*
Monthly Amount
*
Terms and Disclosure
IF CREDIT IS EXTENDED TO YOU OR YOUR BUSINESS THE FOLLOWING TERMS SHALL APPLY:
1. The undersigned (an authorized representative of the company requesting credit terms) agrees to all stipulations and criteria herein contained within this document. This is a legal and binding contract.
1. NET DUE DATE — Purchases are due in full thirty (30) days from the date of the invoice.
2. FINANCE CHARGES – Any account balance not paid in full by the Net Due Date will be accessed a finance charge. Finance charges will continue to accrue until the balance is paid in full. The finance charge will be computed on the past due portion of the account following the net due date. Finance charges are accessed at a Periodic Month Rate (PRM) of 1½%, equivalent to an Annual Percentage Rate (APR) of 18%.
3. Baucom’s Nursery Company reserves the right to withdraw credit privileges without prior notice.
4. Failure of the customer to pay as required on the net due date may result in the loss of charge status. The customer may be deemed Cash on Demand/Delivery (COD), and must pay in full, in the method established by Baucom’s Nursery Company prior to or at the time of delivery.
5. If Baucom’s Nursery Company deems litigation is necessary to collect on this account, the customer agrees that they shall be liable for all costs, damages, interest and attorney’s fee, up to and including any appeal of this matter. The customer agrees that Baucom’s Nursery Company may file in whatever province they deem suitable. The customer waives any and all rights to select or determine the venue of litigation.
6. It is understood and agreed that Baucom’s Nursery Company after reviewing this application may request a financial statement to be completed in detail. The undersigned understands the terms of sale, and agrees to comply with the policies and procedures established with the signing of this document if Baucom’s Nursery Company extends a line of credit.
The undersigned certifies that all the information on this form is correct and hereby agrees that all payment shall be made as set forth under the terms and disclosure set forth above,
Applicant's Signature
*
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Applicant's Name
*
First
Last
Applicant's Title
*
Company represented
*
Date
*
MM slash DD slash YYYY
Witness' Signature
*
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Witness' Name
*
First
Last
Date
*
MM slash DD slash YYYY
Billing Instructions
Purchase Order Required
*
Yes
No
What is required for the purchase order?
*
Hardcopy
Purchase Number Only
Purchasing Agent(s)
*
Purchasing Agent's Email
*
Enter Email
Confirm Email
Purchasing Agent's Phone
Purchasing Agent's Phone Extension
Accounts Payable Information
Accounts Payable Contact Name 1
*
First
Last
Phone
*
Email
*
Enter Email
Confirm Email
Accounts Payable Contact Name 2
*
First
Last
Phone
*
Email
*
Enter Email
Confirm Email
Agreement
For and in consideration of the sum of one dollar ($1.00) in hand paid to the undersigned by Baucom's Nursery Company, and in further consideration of the undersigned, Baucom's Nursery Company shall review and consider extending credit to the below named Guarantor. The undersigned unconditionally hereby guarantees payment of any and all debts which may be owed to Baucom's Nursery, hereafter by the below named Company, and upon demand of Baucom's Nursery Company and without requiring Baucom's Nursery Company to institute any legal action or to take any other type of action against the below named Guarantor.
The undersigned will pay the Baucom's Nursery Company the total amount of the indebtedness owed to Baucom's Nursery Company, plus interest at the highest statutory rate.
Company Name
*
Guarantor's Signature
*
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Guarantor's Name
*
First
Last
Guarantor's Social Security Number
*
Guarantor's Home Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Guarantor's Phone
*
Authorization
I do hereby authorize Baucom's Nursery Company to request and receive information about our account. I understand this is soley for credit determination and this information will be held in the strictest confidence.
Date
*
MM slash DD slash YYYY
Applicant's Signature
*
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Signature locked. Reset to sign again
Applicant's Name
*
First
Last
Company Name
*
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