New Customer Sign Up — Revolution Wholesale

New Customer Sign UP

Printable Form

Electronic Payment Form

Company Information

Company Name (DBA on ABLE license - not LLC)

ABLE License Type

ABLE License Number

Please include alphanumeric prefix (ex. RET-123456).

Check if your liquor license is currently pending

License Expiration Date

YYYY

Business Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

County

Contact Information

Primary Contact Name

First Name

Last Name

Primary Contact Job Title

Primary Contact Phone

(###)

###

####

Primary Contact Email

Additional Contact Name

First Name

Last Name

Additional Contact Job Title

Additional Contact Phone

(###)

###

####

Additional Contact Email

Text

Accounts Payable Information

Accounts Payable Name

First Name

Last Name

Accounts Payable Title

Accounts Payable Phone

(###)

###

####

Accounts Payable Email

Terms

Please see red button at the top of this form for ACH form. Per Oklahoma law, we cannot accept credit cards.

Message

Delivery Information

Delivery Hours Start Time

Hour

Minute

Second

Delivery Hours End Time

Hour

Minute

Second

Please indicate any days you may be closed:

(if applicable)

Monday

Tuesday

Wednesday

Thursday

Friday

Delivery Instructions

Special delivery instructions (back door, alley, closed for lunch, call ahead information, security code, etc.)

Sales Rep (if known)

Please return form & copy of voided check (ACH only) to newaccounts@revolutionok.com.