New Retailer Application

New Retailer Application

For retailers interested in carrying our products, please complete this application to be added to our system.
Business Information
DBA Name
Legal Business Name
Business Address

Street Address

Street Address Line 2
CityStateZip Code
County
Phone Number
Please key in your 10 digit phone number with no dashes (EXAMPLE: 5556667777)Format: (000) 000-0000.
Owner's Name

First NameLast Name
Buyer's Name

First NameLast Name
Email
example@example.com
Will you be carrying alcohol products?

Acknowledgements
Wil Fischer Companies requires all retailers to utilize their Auto-Pay services for the payment of invoices.
Wil Fischer Companies has market specific minimum order requirements in order to receive a delivery. Ask a local rep if you have further questions.
Deliveries from Wil Fischer Companies incur a nominal fee automatically added to the invoice.
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