REGISTRATION – Alliance Distributors

Online Registration Form

Instructions: Please fill out all fields. Download and submit Alliance Wholesale / Distributors Terms of Credit & Application Agreement, Copy of TABC License, and Copy of Mississippi Retail Sales Tax Certification.

User Name

Business Legal Name

DBA or Tradename

Phone

Billing Address

Classification of Business

Type of Store

Number of Stores

Store Owner's Full Name

Store Owner's Phone

Store Owner's Email

A/P Contact's Full Name

A/P Contact's Phone

A/P Contact's Email

Mississippi Retail Sales Tax Id

TABC License Number

Instructions: Please download and complete application. When completed email to support@alliance-distributors.com

Alliance Wholesale / Distributors Terms of Credit & Application Agreement