New Farm Customer Form | I&B Ag Supply

New Farm Customer Questionnaire

Company Name *

Mailing Address *

Office Phone Number *

Primary Billing Contact Name *

Primary Billing Contact Phone Number *

Primary Billing Contact Email *

Shipping Address 1 *

Does this address having a loading dock available? *

Do you have multiple shipping addresses? *

If Yes, please list the multiple shipping addresses in this text box below and note if there is a loading dock available.

Name of your sales representative *

Are you sales tax exempt? *

If yes, please provide a copy of your sales tax exemption form before you complete this questionnaire to [email protected] in order to avoid being charged sales tax.

Does your company have a pesticide dealer, applicator, or other chemical license from your state? *

If yes, please upload a copy of your license or email a copy of your license to [email protected]

Click on the arrow and upload the copy of your license.

By submitting this form and signing up for texts, you consent to receive conversational text messages (e.g., intake reminders) from I&B Ag Supply at the number provided. Consent is not a condition of purchase. Msg & data rates may apply. Msg frequency varies. Unsubscribe at any time by replying STOP. Reply HELP for help. *

I agree to receive marketing texts e.g shopping offers at the number provides

I agree to receive non-marketing texts e.g appointment reminders updates at the number provided

I confirm all the information above is accurate. *

yes

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