Spotted Horse Rum-Dealer/ Distributor Application Form

Spotted Horse Rum-Dealer/ Distributor Application Form

Thank you for your interest in becoming an official dealer of Spotted Horse Rum. Please complete this application form accurately. Our team will review your submission and contact you regarding next steps.
SECTION 1 - Company / Applicant Information
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Business Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Company Name*
Business License Number*
SECTION 2 - Business Profile
Type of Business*
Years in Business
Business Registration Number
Tax ID / VAT Number
Number of Outlets
SECTION 3 - Order & Accounts
Order Contact Name

First NameLast Name
Order Contact Phone Number
Please enter a valid phone number.
Order Contact Email
example@example.com
Accounts / Billing Contact Name
Accounts Contact Phone Number
Please enter a valid phone number.
Accounts Contact Email
example@example.com
Additional Comments or Questions
SECTION 4- Agreement and Declaration

I hereby declare that the information provided is true and accurate to the best of my knowledge and agree to comply with Spotted Horse Rum distribution policies.
Signature

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Date

MonthDayYear
Date
I agree to the terms and conditions
Should be Empty:

SECTION 1 - Company / Applicant Information