New Customers Customers If you are a new customer, please fill out the new customer form below. If you would like your account to be set up on Electronic Funds Transfer (EFT) for your purchases, please visit the Fintech Enrollment Page. New Customer Form Business InformationDoing Business As(Required)(Name of the business as operating either as a sole entity or Doing Business As (DBA), i.e., Boise Sales Company, DBA Idaho Wine Merchant) Business Legal License Name(Required)(Business name as it appears on your license. Required for all businesses)Are you taking over an existing business? Yes No Previous Legal Name(Required)(Business name as it appears on the license for the previous business name, if different)Physical Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County(i.e., Ada, Boise, etc.)Mailing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone #(Required)(Primary contact phone number)Second Phone #Secondary contact phone numberBuyer's Name(Required) First Last Buyer's TitleBuyer's Email(Required) Type of License(Required)On Premise: Restaurant, Bar, Coffee Shop, etc.Off Premise: Retail StoreWhat time of the day do you accept deliveries?Receiving Start Time:(Required) Hours : Minutes AM PM AM/PM Please indicate what time of day you start your receiving.Receiving End Time:(Required) Hours : Minutes AM PM AM/PM Please indicate what time of day you end your receiving.Product Type Beer Beer & Wine Non-alcohol All of the above! Other State Beer LicenseState Beer & Wine LicenseAccount Classification(Required)Select OneAdult EntertainmentAirlinesAsian RestaurantBar / RestaurantBar / TavernBottle ShopBowling CenterCafé / RestaurantCasinoCasual DiningCateringChain Casual DiningChain Fine DiningConcessionaireFine DiningFranternal OrganizationGolf / Country ClubHotel / MotelItalian RestaurantMexican RestaurantNight ClubNon Alcohol onlyPizzaPrivate ClubSeasonal ResortSpecial / License TempSports BarWineryBottle Shop Off PremiseChain ConvenienceChain GroceryIndependent ConvenienceDrug StoreEthnic GroceryFuel onlyLiquor StoreMass MerchantMexican GroceryMilitary Off PremiseNeighborhood storeNon Alcohol Off PremiseSpecial Account Off PremiseSuper CenterSuper MarketWholesale ClubAirportAt WorkBookstoreCoffeeCollegeDeliDeli NT On PremiseGymHospitalMilitary On PremiseMilitary Off PremiseMovie TheaterNon Trad Off PremiseNon Trad On PremiseSpecialty ShopSport ShopVending CompanySelect Payment Method(Required) Cash or Check on Delivery Fintech ACH [Click Here to Download Form] (if choosing Fintech, please contact YOUR Fintech representative; this choice requires an external operation)Form InformationWho is filling out this form?(Required)*** BELOW FOR INTERNAL USE ONLY ***Sales RepresentativeCall day(s) for Sales PersonDelivery DayDelivery Route
