State of Tennessee

Boxwood Shipping Notification

Consumer and Industry Services, Plant Certification
P.O. Box 40627, Nashville, TN 37204
Phone (615) 837-5137 FAX (615) 837-5246
www.tn.gov/agriculture/department/cis

Receiver Business Name:*

License Number:*

Receiver Address:*

Address Line 1

Address Line 2

City

State

ZIP Code

Shipper Business Name:*

Shipper Phone:*

Shipper Fax:

Shipper Email:*

County/State of Origin:*

Varieties and Quantities (or attach invoice):*

Attach Invoice if Applicable

No File Chosen

File uploads may not work on some mobile devices.

Expected Delivery Date:*

Shipper Certificate Number:*

Shipper Boxwood Compliance Number:*

Invoice Number: