CONNECTICUT - Brescome BartonRETAIL Customer order guide ROCK'N Vodka - Open Liquor Order Form - Connecticut Retailers only Connecticut Liquor Order Form FOR CONNECTICUT RETAILERS WITH A VALID LIQUOR LICENSE Account Name * Account Number * Federal Tax I.D. Number (FEIN or S.S.) State Alcohol Beverage License Number License Expiration Date MM DD YYYY Billing Address * Delivery Address * Email * ROCK'N VODKA 750ML - 40% ALC./VOL. (80 PROOF) - 12 BOTTLES / CASE Per Bottle Pricing $17.99 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 Brescome Barton. KISS - Open Liquor Order Form - Connecticut Retailers only Connecticut Liquor Order Form - KISS FOR CONNECTICUT RETAILERS WITH A VALID LIQUOR LICENSE Account Name * Account Number * Federal Tax I.D. Number (FEIN or S.S.) State Alcohol Beverage License Number License Expiration Date MM DD YYYY Billing Address * Delivery Address * Email * KISS COLD GIN, BLACK DIAMOND RUM, DETROIT ROCK RUM & MONSTRUM Per Bottle Pricing 1 Case Cold Gin $27.00 Black Diamond $35.00 Detroit Rum $44.00 Monstrum $146.00 Product & 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 Brescome Barton.
