New Customers

Welcome new customers! Please fill out the form below to begin setting up your account in to our system. After completing the form you will be contacted by our admin team to finish the process.

Thank you and we are excited to start serving you!

New Customer Submission Form:

Please enable JavaScript in your browser to complete this form.

Company Name *

What would you like to purchase from us? *

• Beer
• Wine/Cider
• Non-Alcoholic (like Soft Drinks, Juice, Water)

Do you want to pay electronically? *

• Yes
• No

What is the trade name on your permit?

Primary Contact Name *

First

Last

Primary Contact Email *

Primary Contact Phone *

Business Phone *

Physical Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Is this the same as the Mailing Address? *

• Yes
• No

Mailing Address

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

County *Select a countyAlexanderAlleghanyAsheAveryBurkeCabarrusCaldwellCatawbaDavidsonDavieGastonIredellLincolnMontgomeryRowanStanlySurryWataugaWilkesYadkin

W-9 Form

Click or drag a file to this area to upload.

Do you have a NC Tax Exemption form filled out and ready to upload? *

• Yes
• No

NC Tax Exemption Form

Click or drag a file to this area to upload.

Please click on the link below to fill out the NC Tax Exmption Form and submit

NC E595E Tax Exemption Form

Submit