Please enable JavaScript in your browser to complete this form.Business Information - Step 1 of 8Legal Name *Trade Name *Have you ever been a customer with Elite Wines? *YesNoAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBusiness Phone # *Business Fax #Website / URLBusiness Email *Next-Location & Premise InfoType of Location *RestaurantRestaurantBarMarket/GroceryWine StoreNight ClubWineryCatererType of Premise *On PremiseOff PremiseNext-Licence & Tax InfoLicense Number *Sales & Use Tax # *ABC LICENSE & TAX CERT * Click or drag files to this area to upload. You can upload up to 2 files. TAP TO TAKE A PHOTO ON MOBILE , TAKE ONE PICTURE OF EACH - PLEASE MAKE SURE IT IS CLEARNext-Entity & Owner InfoEntity Type *CorporationLLCPartnershipSole ProprietorshipSocial Security # (If a Sole Proprietorship) *Federal ID# *Names of Owners *FirstLastNames of additional ownersFirstLastNext-Wine Buyer InfoWine Buyer NameFirstLastWine Buyer(s) EmailName of Elite Wines Rep. - OptionalEnter your Sales Reps. Name here if you already have one.Next-Accounts Payable infoAccounts Payable Contact *FirstLastAccounts Payable Email *Next-Delivery InfoHours of Operation *Delivery Days and Hours *Delivery Instructions *Next-Payment InfoHow will you be making payments? *CODFINTECH - VACREDIT/TERMS DC/MD ONLYFINTECH - DC/MD CREDIT/TERMSACHGuarantor Applying For Credit - MUST FILL IN NAME THAT IS SIGNING *FirstLastFor and in consideration of the Seller (Elite Wines®) extending credit to the Applicant and with the understanding that without this Guarantee Seller would not extend such credit, the undersigned Guarantor hereby personally guarantees the payment of any obligation of the Applicant to the Seller. Therefore, Guarantor hereby agrees to pay the Seller on demand, without offset, any sum due to the Seller by the Applicant if and when Applicant fails to pay such amount. Guarantor further agrees to pay all costs of collecting including 30% attorney’s fees. This Guarantee shall be a continuing and irrevocable guarantee for indebtedness of the Applicant. Furthermore, Guarantor consents to and waives notice of any modification, amendment or extension of the credit agreement hereby guaranteed. By selecting the "Submit" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement.Title *OfficerDirectorOwnerPrincipalDate *Signature * Clear Signature Submit