Florida - Green Light DistributionRETAIL Customer order guide Open Customer Registration Form Florida Customer Information Form Date * MM DD YYYY Company /DBA / Corporation * State Alcohol Beverage License Number (TABC) * Expiration Date * Tax ID, Resale Permit Number * Business Phone * (###) ### #### Business Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Sales Rep Name Buyer Name * First Name Last Name Buyer Phone * (###) ### #### Buyer Email * Delivery Times and Days * Additional Delivery Instructions Accounts Payable Contact Name: * Accounts Payable Phone (###) ### #### Accounts Payable Email * Type of Business * Bar/Nightclub Wine Bar Catering C Store Grocery Hotel/Motel Liquor/Package Military Restaurant Wine Shop On Premise Check Appropriate Boxes * State Terms - Net 10 Days COD (Collect on Delivery) FINTECH COD FINTECH Bi-Monthly Currently on Fintech New to Fintech N/A Signed Home Address Home Phone Cell Phone Email Corporation / DBA / Trade Name * Signed * Date * MM DD YYYY Thanks for registering for distribution in Florida! Please place your order for ROCK’N Vodka with the Liquor Order Form. Open Liquor Order Form - Florida Retailers Only Florida Liquor Order Form Account Name * Billing Address * Delivery Address * Email * ROCK'N VODKA 750ML - 40% ALC./VOL. (80 PROOF) - 12 BOTTLES / CASE Per Bottle Pricing Off-Premise 5 Cases - $22.33 25 Cases - $21.33 50 Cases - $19.92 On-Premises 1 Bottle - $19.92 Single Bottles or Cases * Single Bottles Cases Quantity * PO Reference Number Order Date MM DD YYYY Requested Delivery Date FOR FLORIDA RETAILERS WITH A VALID LIQUOR LICENSE Sales Representative * First Name Last Name Thank you for the order! Please complete the Customer Registration Form if you’re not yet with Green Light Distribution.
