Gardening Products | Portland, OR

McFarlane’s Bark, Inc

Account Applicant Information

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Date

CHECK ONE: C.O.D. Account

Charge Account

Credit Limit Desired

Business Name

Type of Business

Business Address

City

Zip

Billing Address (if different)

City

State

Zip

Billing contact E-Mail address

Business Contact Name

E-Mail Address

Email Statements?

Yes

Office Phone

Cellphone Number

Fax

Years in Business

Federal Tax ID #

WA State Tax (Include Copy of Resale Certificate)

Alternative authorized business contact

Phone

Address

City

State

Zip

Free Text

In addition, complete this section for NET 30-day charge account

List 3 local trade references. Include phone & E-mail Address, attach additional sheet if necessary. We will wait for contact from these entities.

Free Text

Customer Personal Identification Number

Free Text

To safeguard your account against unauthorized transactions, please complete and provide the P.I.N. to all designated “authorized” personnel. You may update your P.I.N. at any time by calling our administration office at 503-654-1237 or submitting a new form. If you suspect that an unauthorized person has access to your P.I.N., contact our office immediately to request a change

Company Name

P.I.N. = (Minimum of 3-character, maximum of 6)

Signature of Applicant

Print Name of Applicant

Title

Date

VANCOUVER YARD ONLY: FINE COMPOST AND FILL DIRT ON SALE WHILE SUPPLIES LAST.

~FREE COARSE COMPOST AVAILABLE AT THE MILWAUKIE YARD. DELIVERY FEE EXTRA.~

NO STUMPS (12" & larger) ACCEPTED AT EITHER YARD

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***VANCOUVER YARD ONLY: FINE COMPOST AND FILL DIRT ON SALE WHILE SUPPLIES LAST.***

~FREE COARSE COMPOST AVAILABLE AT THE MILWAUKIE YARD. *DELIVERY FEE EXTRA.*~

**NO STUMPS (12" & larger) ACCEPTED AT EITHER YARD**

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VANCOUVER YARD ONLY: FINE COMPOST AND FILL DIRT ON SALE WHILE SUPPLIES LAST.

~FREE COARSE COMPOST AVAILABLE AT THE MILWAUKIE YARD. DELIVERY FEE EXTRA.~

NO STUMPS (12" & larger) ACCEPTED AT EITHER YARD