Miramar Wholesale Nurseries, Inc.


In order to initiate a new account, please fill out and submit the form below. We will send you the appropriate credit or cash application and a member of our sales team will contact you.

*Business Info* * Company Name
* Company Address
* City
* State
* Zip Code
* Company Phone
Company Fax
* Business Contact	Title
E-mail Address
Nature of Business
Please check one:	Corporation Sole Proprietorship Partnership
	If a corporation, when did you become incorporated?
	State of incorporation?
	Year business was established
	At present business address since
	Are the materials you purchase for resale? Yes No
	Applying for: Credit Account or Cash Account