Wholesale Customer Application

Purchasing Qualifications
QUALIFIED BUYERS MUST BE:
(A.) Retailers, Wholesalers, or Manufacturers with State Tax Exempt status,
(B.) Non-Profit Organizations with Tax Exempt Status (NP-1) – Please note the IDOR requires an NP-1 vs. the ST-105 for Non-Profits beginning 1.1.2024, or
(C.) Landscaper or Nursery Dealer License
We request to see either the actual document or a copy; we are unable to accept the license number only
Please complete the following information to begin the customer application process. When submitting an application, please include all other requested documentation. Please also notice the customer purchasing guidelines located on the previous page for additional terms and conditions to purchasing.

Wholesale Customer Application

Business Name*
Main Purchasing Agent*
First Last
Type of Business
Mailing Address
Street Address*
Street Address City State ZIP Code
Phone*
Fax
Email*
Authorized Buyers (Max of 4 per Business)*
DOCUMENTS

To be considered, please make sure to upload at least one of the following:
– Retail Certificate
– Landscaper or Nursery Dealer License
– Completed Non-Profit Tax-Exempt Status Form (NP-1) or your Business Tax Exempt Form (ST-105)
File Upload*
Drop files here or

Max. file size: 2 MB, Max. files: 3.
VERIFICATION
Date*
MM slash DD slash YYYY
Acknowledgement*
- By checking this box, I certify the information on this application is factually correct to the best of my knowledge.
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Heartland Growers

Wholesale Customers

Wholesale Customer Application