New Client Credit Application

Visual icon depicting an application to be filled out and signed.

New Client
Credit Application

Are you a new client? If you would like to apply for a credit account, please fill out the form below, and our credit department will process your application and inform you of the status.

Step 1 of 5

Business Information
Please provide us details about your business:
Business Name: * Required
Phone * Required
Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email Address * Required

Invoices will be emailed. Please provide email address for your accounts payable (AP) department.
Type of Ownership * Required
- Corporation
- Partnership
- Proprietorship
- LLC
Tax ID No. * Required
Resale No. * Required
ABC License No. * Required
Bonded Winery No. * Required

Principal Owners or Officers
We have provided fields for two owners/officers. If you have more than two principals, please contact us for a printable application.
Name * Required
First Last
Title * Required
Email * Required
Percent % of Ownership * Required
Home or Mobile Phone * Required
Home Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Social Security No. * Required
Driver's License No. * Required
Name
First Last
Title
Percent % of Ownership
Email
Home or Mobile Phone * Required
Home Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Social Security No. * Required
Driver's License No. * Required

Credit References
Please provide two references; preferably other custom crush facilities, if available.
Reference #1: Supplier Name * Required
Email * Required
Phone * Required
Fax
Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference #2: Supplier Name * Required
Email * Required
Phone * Required
Fax
Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Bank References
Please provide at least ONE bank reference.
Main Bank * Required
Branch * Required
Contact Name * Required
Contact Email * Required
Contact Phone * Required
Fax
Branch Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Checking Account No. * Required
Savings Account No. * Required

Terms of Sale
Terms of payment are "net 15 days" unless otherwise stated. Balances unpaid beyond the terms are subject to a service charge of 1.5% per month (or the maximum permissible rate under applicable law, whichever is less) on the unpaid balance.

The undersigned purchaser agrees to pay any legal fees or third-party costs involved in collection and agrees to notify RB Wine Associates LLC (DBA Rack & Riddle Custom Wine Services) of any change in ownership.

The undersigned agrees to release credit information to RB Wine Associates LLC (DBA Rack & Riddle Custom Wine Services) credit and collections department. It is understood that the information will be held in strict confidence and is for the sole purpose of extending credit or updating existing credit files.

By signing below (digitally), purchaser accepts the terms of this application, and agrees that, in the event of any inconsistency between the terms hereof and the terms of the purchase order or other documents, the terms hereof will control. Any disputes shall be governed by the laws of the State of California, the courts of which shall have exclusive jurisdiction.
Signature * Required
NOTE: Please Sign using your mouse, fingertip, or a stylus, depending on the device you are signing on. This is a digital signature and is treated the same as a standard signature.
First and Last Name of Signer * Required
First Last
Date Signed * Required
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

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New Client Credit Application

New Client Credit Application

Step 1 of 5

Business Information

Principal Owners or Officers

Credit References

Bank References

Terms of Sale

LET'S COLLABORATE

New Client
Credit Application