New Customer Sign UP Printable Form Electronic Payment Form Company Information Company Name (DBA on ABLE license - not LLC) * ABLE License Type * On-Premise Off-Premise Special Event ABLE License Number * Please include alphanumeric prefix (ex. RET-123456). Check if your liquor license is currently pending License Expiration Date * MM DD 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. Due on Receipt (Cash/Check) ACH Fintech EFT iControl Message Delivery Information Delivery Hours Start Time Hour Minute Second AM PM Delivery Hours End Time Hour Minute Second AM PM 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) Thank you for signing up with Revolution Wholesale! A team member will be in contact with you shortly. If you have any questions, please reach out to our office staff at newaccounts@revolutionok.com. Please return form & copy of voided check (ACH only) to newaccounts@revolutionok.com.
