Name * First Name Last Name Email * Phone (###) ### #### Illinois Liquor License Number * Illinois Beverage Tax (IBT) Number Expiration Date * MM DD YYYY Corporate Name: * DBA: Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Business Phone * (###) ### #### Preferred Delivery Day * Select one Tuesday Wednesday Thursday Friday Delivery Window Delivery Instructions Name of owner, partner or officer First Name Last Name Accounts Payable Contact Name First Name Last Name Email - accounts payable Are you an existing Fintech customer? * Yes No Don't know Do you have a Sales Rep from High Road you are working with or request? For orders, do you prefer to be contacted by email or text? Email Text This application is submitted for the purpose of obtaining credit with HIGH ROAD WINE & SPIRITS OF ILLINOIS (HRWS) and is warranted to be true. By signing this application, the undersigned acknowledges that he/she is authorized to execute this application and to obligate the company to make payment in full for all amounts due according to invoice on or before the net due date. As a matter of business, the commerce relationship between HRWS and the customer are governed by the ILLINOIS LIQUOR CONTROL COMMISSION and its “30 DAY CREDIT LAW”. Distributors are prohibited from delivering to retailers who are past due. Deliveries to retailers who have invoices more than 30 days old on the distributor’s books must cease as of the 31st day, irrespective of whether the retailer .has been posted delinquent with the State. The 30-day period commences the day after the invoice date. It includes weekends and holidays and may in fact expire on a non-business day. You can learn more about the regulatory requirements for both wholesaler and retailer here: www2.illinois.gov/ilcc. HIGH ROAD WINE & SPIRITS New Customer Application Form.Application must be filled out completely.
