Account Setup Customer Information and Account Setup General Informationbio365 Representative*UnsureDonnie LokeySebastian McIntyreVanessa FieldsJohn BoninBusiness Name*Business Entity* Individual LLC Partnership Corporation Taxpayer ID:*Please upload your sales tax exemption formIf applicable, provide proof of your exemption from sales tax in your state. If you are a retailer, this is your state's resale certificate. Drop files here or Select files Max. file size: 200 MB. Phone*Website Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Shipping address same as Billing Address Shipping address same as Billing Address Shipping Address (if different) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Is this a residence?* Yes No Is a liftgate for delivery required?* Yes No Do you have a pallet jack?* Yes No Do you have a forklift?* Yes No Do you have a loading dock?* Yes No Days you can receive deliveries Mon Tue Wed Thur Fri Sat Sun Hours you can receive deliveriesDelivery notes:ContactsOwner or Executive Name Title Email Phone Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Accounts Payable Name Title Email Phone Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Head Cultivator Name Title Email Phone Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Approved Purchasers (to add a second approved purchaser, click the green (+) symbol. Name Title Email Phone Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Delivery Coordinator Name Title Email Phone Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Terms and ConditionsAll samples and sales are subject to bio365’s Terms and Conditions: https://www.bio365.com/terms I accept the Terms and Conditions. Print Name*Date* MM slash DD slash YYYY Signature* Δ If you experience errors using this form, try again using the Google Chrome, Safari or Microsoft Edge browser.
