New Account Application

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Account Contact Information

DBA Name
DBA Name
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Account's Physical Address

Address
Account Address
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City
Account City
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State
  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
- select a state -
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Zipcode
Account Zipcode
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Primary Contact Information

Name
Name
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Email
Your E-mail Address
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Cell
Your Phone number
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Invalid phonenumber!
The Primary Contact is also the:
(select all that apply)
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License Name
License Name
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CABC License #
CABC License #
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Tell us a little more about your business

Type of business?
Type of business?
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Hours of operation?
Hours of operation?
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Preferred Delivery Days
Preferred Delivery Days
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Preferred Delivery Hours
Preferred Delivery Hours
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Is account seasonal?
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Alcohol consumed on premise?
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Chain?
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This account carries:
(select all that apply)
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Special instructions for delivery?
(Front door, back door, side door?)
Special instructions for delivery?
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Billing Information

Billing Address
Billing Address
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City
Billing City
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State
  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
- select a state -
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Field is required!
Zip Code
Billing Zipcode
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Federal Tax Identification #
Federal Tax Identification Number
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Reseller Permit #
Reseller Permit #
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Terms & Conditions

I hereby certify that the information contained herein is complete and accurate, and the person executing this agreement has authority to bind the retailer and is authorized by the retailer to enter into transactions with RLED, LLC. Further, I certify that my the following are valid and in good standing: CABC alcohol license, reseller permit/tax exempt status, and business entity status with the Secretary of State of California. Finally, this information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit terms to be extended. All credit terms will be in compliance with state alcohol laws and regulations. The undersigned understands that RLED LLC dba Bar Beverages must be notified in writing by certified mail of any change in ownership, the name or business structure under which credit is established. The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national original, sex, marital status, age, (provided the applicant has the capacity to enter into a binding contract), because all or part of the applicants income derives from any public assistance program, or because the applicant has in good faith exercised any right under the consumer credit protection act to the extent is would apply.
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