Become a customer

Backup Beverage: Become a Customer
In order to proceed, you must certify that you are a licensed Alcoholic Beverage Retailer / Licensee in the STATE of MARYLAND.

Backup Beverage is not a retailer or direct shipper of alcohol to individuals.
I Certify that I am a licensed Alcohol Licensee in the State of Maryland

NEW CUSTOMER FORM (Basic Info)
By providing the following infomation, you will best assitst us in our efforts to provide the highest level of service to your business.
Business Name
DBA (If Different than Business Name)
Street Address
City
State
Zip Code
Buyer's Name
Buyer's Phone #
Buyer's Email Address
Business Owner's Name
Business Phone #
Business Fax #
Business Email Address

NEW CUSTOMER FORM (License and Preferences)
License #
License Expiration Date

MonthDayYear
Preferred Delivery Times/ Delivery Instructions
Premise Type
Do you require a purchase # order with each delivery?
County
*We do not service Montgomery County
Growler Station / Growlers Filled?
Require Tap Handles (or stickers) for Kegs sold On-Premise (including Growler Stations)
Should be Empty: