Farm Cash Account Application

A cash account allows you to pay for your products when you arrive to pick up the supplies from a Growers Supply Co. location. This account also allows you to visit any of the Growers Supply Co. locations and buy directly from the store. A cash account’s balance must always be paid in full, upon the collection of your supplies.

*Proof of farm or acreage must be provided, before your application can be processed. This form must be completed in full.*

Please note that a PST certificate of exemption of a farmer is required on file for PST exemptions.

General Farm Information

Farm Name

Owner's Name *

First

Last

Owner's Name (secondary)

First

Last

PST Exemption Number

Applicators Licence #

Proof of Farm/Land Status *

Click or drag a file to this area to upload.

Farm Mailing Address

Farm Mailing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Farm Delivery Address

(if different from mailing address)

Farm Delivery Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Contact Information

Phone *

Cell Phone *

Fax

Email *

Acres/Hectares *

Type

Expiry Date

Additional Contacts (if applicable)

Name

Phone

Cell Phone

Fax

Relationship to account holder

Position title

Agreement

Signature *

Title *

Date *