Credit Application for Business Account Form

License Information

A COPY OF YOUR LIQUOR LICENSE MUST BE PROVIDED ALONG WITH A COMPLETED AND SIGNED RESALE CERTIFICATE FORM ST-120 PRIOR TO ANY DELIVERIES
License Serial #*
License Certificate #*
License Expiration*

MonthDayYear
Date
Federal Tax ID*

Agreement

(By checking these boxes you are agreeing to our terms - should you have any questions please contact us)
Agreement and Terms*

Excluding the opening buy special. All invoices are to be paid 30 days from the date of the invoice.
Agreement and Terms*

Claims arising from invoices must be made within 7 business days of the invoice date.
Agreement and Terms*

By submitting this credit application, you authorize us to make inquires into the banking and buisness references that you provided.
Enter the word as it's shown*
Signature

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Accounts Payable Information