MVLNA
Mahoning Valley Landscape and Nursery Association
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Application for Membership
Name
First
Last
Home Phone
Business Name
Business Mailing Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Is Your Business street address different than mailing address?
*
No
Yes
Business Street (Physical) Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Type of Business:
*
Individual
Partnership
Corporation
First Year Business Operated
Approximate Number of Employees
Number of Full-Time Employees
Number of Part-Time Employees
Have you previously been a member of the Mahoning Valley Landscape and Nursery Association?
*
Yes
No
What year(s) were you a member?
If you are a member of any of the following professional organizations, please check below
Ohio Nursery and Landscape Association
Ohio Landscape Association
American Nusery and Landscape Association
Ohio Lawn Care Association
Did an MVLNA member recommend you to join?
*
Yes
No
Name of member
Phone of member
Business Information
Name of Your Business Liability Insurance Company
Insurance Company Phone Number
Federal ID Number
Workers' Compensation Risk Number
(For information go to www.ohiobwc.com)
State (OH or PA) Service Vendor's or Vendor's License Number
(To obtain a Service Vendor's License in Ohio, go to http://business.ohio.gov)
Your State Nursery Stock Producer's/Dealer's Certificate Number (if applicable)
(To obtain an Ohio Nursery Stock Producer's/Dealer's Certificate, call the ODA at 800 282-1955)
State Applicator's License Number (if applicable)
(To obtain an Ohio Applicator's License, go to: www.agri.ohio.gov)
Do you subcontract all your applications?
Yes
No
If yes, please list Vendor's Name
Membership Type
I am applying for
Regular Membership
Associate Membership