New Customer Form

If you're a new customer, please submit the form below.

If you prefer, please fill out the form at this link and send to your sales representative.

New Customer Setup Form & Credit Application

Business Name *

Business Address *

Full Address: Street, City, Zip Code

Phone *

Delivery Address *

Full Address: Street, City, Zip Code

Accounts Payable Information *

AP Contact Name, Email Address

Billing Address *

Full Address: Street, City, Zip Code

Requested payment terms (i.e. COD, Prepay, Net 30, etc.) *

Prior to approval of payment terms, all sales are considered prepaid. Payment terms are subject to review and approval by the NewAge Finance team based upon the credit application, credit history, and credit references

Are Purchase Orders required? *

Monthly Statement Delivery Method *

Email
Mail (USPS)

Please provide preferred statement email or physical address: *

Type of Company (please provide a W9) *

Corporation
Partnership

EIN# *

Years in Business *

Reseller's Certificate # *

(If provided, please write '(sent)' after the certificate number)

Liquor License # (if relevant) *

(If provided, please write '(sent)' after the certificate number)

Reference #1 *

Company Name, Contact Name and Title, Address, Phone, Email

Reference #2 *

Company Name, Contact Name and Title, Address, Phone, Email

Reference #3 *

Company Name, Contact Name and Title, Address, Phone, Email

Bank Reference *

Bank Name and Account Number, Contact Name and Title, Address, Phone, Email

By checking 'yes' applicant hereby authorizes NewAge to obtain anuy information and to make any inquiries that are deemed appropriate in order to determine Applicant's credit worthiness and determine whether credit terms will be extended to the applicant *

Yes, I authorize

Name of Signer *

First

Last

New Customer Form

GDPR