ARIZONA - ATLANTIS BEVERAGE CO.RETAIL Customer order guide Open Customer Registration Form Arizona Customer Information Account Name * Contact Name * First Name Last Name Phone * (###) ### #### Federal Tax I.D. Number (FEIN or S.S.) * State Alcohol Beverage License Number * Expiration Date Delivery Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Accounts Payable Contact Name: * Accounts Payable Phone * (###) ### #### Accounts Payable Email * Billing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Type of Business * Convenience Store Liquor Store Grocery Store Restaurant Bar/Tavern Country Club Casino/Resort/Hotel Other Thanks for registering for distribution in Arizona! Please place your order for ROCK’N Vodka with the Liquor Order Form. Open Liquor Order Form - Arizona Retailers Only Arizona Liquor Order Form FOR ARIZONA RETAILERS WITH A VALID LIQUOR LICENSE Account Name * Billing Address * Delivery Address * Email * ROCK'N VODKA 750ML - 40% ALC./VOL. (80 PROOF) - 12 BOTTLES / CASE Per Bottle Pricing $20.00 - 1 case $19.00 - 2 cases $18.00 - 3 cases $17.00 - 5 cases Single Bottles or Cases * Single Bottles Cases Quantity * PO Reference Number Order Date MM DD YYYY Requested Delivery Date Sales Representative * First Name Last Name Thank you for the order! Please complete the Customer Registration Form if you’re not yet with Atlantis Beverage Co.
