Flipbook TEST

NEW ACCOUNT SET-UP

FINE WINE + SPIRITS

Submit to: Customer Service (FL, GA, Mid-Atlantic, SC, CA, WA, OR) DC / WA - you MUST provide a copy of your ABC license with this form.

or Accounts Receivable (CT, Midwest, NJ, NY, PA)

REP NAME:

DATE:

TERRITORY:

ROUTE:

ACCOUNT INFORMATION

* NAME OF ACCOUNT: (* Must match name on ABC license)

* ADDRESS: CITY: STATE: ZIP: (*Must match address on ABC license)

COUNTY: ( Required in MD) PHONE NUMBER(S): OFFICE: CELL: * EMAIL: FAX: (*Fax # and/or Email address req’d for accounting purposes) STATUS: ON PREMISE OFF PREMISE INDEPENDENT CHAIN CONTACT NAME(S): ABC LICENSE #: EXPIRATION DATE: SALES AND USE TAX CERTIFICATE ID#: ( If applicable) EXPIRATION DATE: PAYMENT TERMS: (Check One) COD DCABC MBJ NET 30 NET 10 Only check what is available in your market (DC Only) (MD Only) (FL Only)

DELIVERY INFORMATION

SHIPPING ADDRESS:

CITY: STATE: ZIP:

NEAREST CROSSROAD :

M

TU

W

TH

F

DAYS & TIMES DELIVERIES CAN BE ACCEPTED: DAYS:

START TIME: END TIME:

DELIVERY ENTRANCE: FRONT DOOR BACK DOOR

BUSINESS HOURS: OPEN TIME: CLOSE TIME: NOTES / SPECIAL INSTRUCTIONS:

****************************************************************** FOR OFFICE USE ONLY ******************************************************************

LICENSE VERIFIED BY: DATE: NEWACCOUNT #: NOTES: