Allied Beverage Group - Customer Registration

Allied Beverage Group, LLC

Customer Registration - Licensed Dispensaries and On-Premise BYOB
Thank you for your interest in working with Allied Beverage Group, LLC. Please complete the form below and click 'Submit' at the bottom. Once submitted, our team will review your application as quickly as possible and will contact you if anything further is needed to complete the application. Once completed and approved, you will receive a welcome letter from our Credit Department with information on how to shop and place orders. We wish you the best in your business and are excited that you have chosen Allied Beverage Group, LLC as a trusted distributor.
Select your establishment type:
Business Information
Corporation or LLC Name
DBA/Trade Name
Class 5 CRC License Number
CRC License Expiration Date

MonthDayYear
Date
DBA/Trade Name Address

Street Address

Street Address Line 2
CityStateZip Code
Mailing address (if different from above)

Street Address

Street Address Line 2
CityStateZip Code
Contact Information
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Personal/Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
NJ Tax ID #
Primary Email Address
At least one email address is required for proof of delivery.
Personnel
Owner Name

First NameMiddle NameLast Name
Owner Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Owner Home Address

Street Address

Street Address Line 2
CityStateZip Code
Any additional owners?
Additional Owner Name

First NameMiddle NameLast Name
Additional Owner Home Address

Street Address

Street Address Line 2
CityStateZip Code
Manager Name

First NameMiddle NameLast Name
Manager Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Do you own or operate any other locations?
Additional location name
Additional location address:

Street Address

Street Address Line 2
CityStateZip Code
Hours of Operation

Hours of Operation (select all that apply):

Rows	Open Time (HH:MM)	Open Time (AM/PM)	Close Time (HH:MM)	Close Time (AM/PM)
Monday
Tuesday
Wednesday
Thursday
Friday

Delivery Information
Earliest Acceptable Delivery Time

Hour Minutes

AM/PM Option
Latest Acceptable Delivery Time

Hour Minutes

AM/PM Option
NOTE: The window between your earliest and latest acceptable delivery times must be at least 5 hours.
Requested Delivery Days (select all that apply)
Payment Terms
Payments: Payment must be made on delivery with a business check, owner's personal check, money order, or certified bank check. Drivers cannot accept cash.

Returned checks: If your check is returned by our bank, your account will be placed on non-delivery until repaid, and a $40 charge will be applied to your account along with the amount of the returned check to be paid back with a certified check. Should that occur, once the account resumes ordering, certified checks will be the only payment type accepted.
Electronic Signature/Attestation and Application Submission
By entering my full, legal name below, I certify that I am the owner or the manager of the business with details specified herein, that I have read and understood the payment terms, and that all details contained in this submission are accurate and truthful, to the best of my knowledge.
Full Legal Name of Owner, representing Electronic Signature/Attestation

First NameMiddle NameLast Name
Upload your CRC Class 5 CDS dispensary license:

Cancelof
Should be Empty:

Allied Beverage Group, LLC

Business Information

Contact Information

Personnel

Hours of Operation

Delivery Information

Payment Terms

Electronic Signature/Attestation and Application Submission