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Reseller’s Account Page

844-542-3421

Full Name

First Name

Last Name

Business Name

Business Phone

(###)

###

####

Primary Business Login Email Address

Used on Login Page

Primary Business Password

Secondary Login Email Address

Secondary for Login Page

Secondary Login Email Pasword

Address

Licensed Premise Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Business Liquor License Number

Business Liquor License Expiration Date

ST120 Resellers Certificate Info, Number and Prep Date

Indicate Products Covered by Liquor License

Check all that apply

Beer

Wine

Spirits

First order being placed?