New Account Form - External

Thank you for your interest in working with us. Please complete the following form in full. We will do our best to get you set up quickly.

Feel free to contact our office with any questions: (845) 419-5157

Tell us about your business:

Will you be buying exclusively non-alcoholic products? *

Which types of products are you interested in buying:*

BeerLiquorCiderNon Alcoholic Products

DBA Name:*

Licensee Name:*

Street Address:*

City:*

Zip Code:*

County:*

Phone Number:*

Area CodePhone Number

Market Type:*

Bar, Deli, Gas Station, Grocery, Home D, Hotel, Package Liquor, etc....

Fax Number:

Area CodePhone Number

Buyer Name:*

Buyer Email:

example@example.com

Buyer Phone #:

Area CodePhone Number

Then we'll need your license info:

Take a photo of NYS SLA Physical License (this should be physically displayed clearly on premises somewhere):*

License Serial #:*

License will be crosschecked on the NYS SLA website.

License Expiration Date:*

MonthDayYear

Are you a chain account?

Chain Account?

Chain Name:

Store #:

Tell us a little more about your business:

Premise Type is...

Package consumption is...:

Draft consumption is...

Pricing

Pricing Group

Unless a Corporate Chain is answered above.

Pricing group:*

Tax, AR & Credit Info:

Please note there will be a $50.00 fee for all returned checks.

Are you interested in enrolling with Fintech, our EFT program?

Federal Tax ID #:*

Take a picture of your tax certificate (should be displayed clearly somewhere on the premises):

Browse Files

File Upload: NYS RESALE CERTIFICATE: ST-120*

Upload a File

Download a pre-filled ST-120 here, please fill out highlighted fields...

Credit terms requested:*

Please list three business references:

Please select or provide three business references:*

Manhattan Beer Distributors, Suffern NY, 845-369-3330Southern Wine & Spirits, Middletown NY, 845-673-1162DeCrescente Dist. Mechanicville, 518-664-9866Saratoga Eagle, Saratoga NY, 12866, 518-581-7377Empire Merchants North,Other

Business Owner's Name:*

Owner's Nameno:

Business Owner's Address:*

Business Owner's Phone #:*

Area CodePhone Number

Are you a sole proprietorship?*

YesNo

Business Owner's SSN:

Please select which Tax ID number you would like to provide:*

FEINEINTIN (Typically posted on the premise)

FEIN:*

EIN:*

TIN:*

By signing below, you agree to the following:

I, for and in consideration of Craft Beer Guild Distributing of New York LLC's approval of this Credit Application for the above mentioned business hereby personally guarantees to Craft Beer Guild Distributing of New York LLC, the payment of all charges and fees which may become due in accordance with the terms and conditions of Craft Beer Guild Distributing of New York LLC's credit terms, whenever the company shall fail to pay the same. I understand this Guaranty shall continue and be irrevocable until all charges and fees are paid or until I receive a written release from the Guaranty. I hereby authorize Craft Beer Guild Distributing of New York LLC to run a background and/or credit check in order to evaluate my credit worthiness.

Business Owners's Signature*

Business Owner's Signature*

Mailing info if different from above:

Is your bookkeeper at a different address?

Billing Street Address:

Billing City:

Billing Zip:

Bookkeeper:

Bookkeeper email:

example@example.com

Bookkeeper Phone #:

Area CodePhone Number

Sales Rep Info

Call Day:*

Before stop:*

After stop:*

Beer Rep Name:*

Specialty Rep Name:

Liquor Rep Name:

ASM Name:*

Delivery Info:

Help us provide you with the best options for delivery.

Requested Delivery Day:*

We will do our best to accommodate your requested delivery day. We will contact you with alternatives if need be.

Delivery Options Available:

DockForkliftOther

Special Delivery Instructions:

"Always see Joe before delivery..."

If the delivery happens on a side street, or NOT at the front entrance of the building, please describe:

"Back door on Maple ave."

Delivery Window:*

Please enter the earliest and latest you are available to accept a delivery Eg. 6am-5pm. Delivery window is required to be a minimum of 4 consecutive hours.

Delivery Window # 2:

A second delivery window may be available, if a receiver goes on lunch for example and then returns.

Would you like to be signed up for electronic statements?*

YesNo

Please enter the email address where you would like to receive electronic statements:

example@example.com

Retailer Email:*

Your Signature:*

Your Signature: *

Would you like to be signed up for Retailer Portal – AR Portal?

Would like to be signed up for Retailer Portal – Online Ordering?

Everything all set? Thank you. We will be reaching out to you shortly!

Age range:

Owner Code:

Patron Code:

Occupation Code: