This form must be filled out completely prior to account approval
  • Business Information

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  • Delivery Information

  • Please select all days deliveries will be accepted and note times & instructions in box to the right
  • Please select your assigned salesperson's name. If you are unsure of your assigned salesperson, one will be assigned to you
  • Ownership Information

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  • Reference Information

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  • Attestation and Signature

  • Applicant's Signature attests financial responsibility, ability and willingness to pay invoices in accordance with the following terms:

    1) Applicant certifies that all statements made in this Application are true and correct, and made for the purpose of obtaining credit. Applicant authorizes parties named above to release credit information to Atlantic Beverage Distributors or it's agents for the purpose of conducting a credit check.

    2) Invoices are net 60 days. Balances over 60 days are subject to a service charge of 1.5% per month (18% per annum). A 1% discount may be taken for invoices paid within 10 days of delivery. Applicant will be assessed a $50 fee for all returned checks.

    3) If Applicant's account is submitted to an attorney for collections, Applicant agrees to pay all costs of collection, including but not limited to, reasonable attorney's fees.