California Account Application

Legal Name

DBA

Federal Tax Identification #

Account Type RestaurantRetailer

California ABC License #

California Resale Certificate #

California Resale Certificate Expiration Date

Billing Address

Billing Address Line 2

Billing City

Billing State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Billing Zip

A/P Contact Name

A/P Telephone

A/P Email (for statements)

Delivery Address

Delivery Address Line 2

Delivery City

Delivery State California

Delivery Zip

Delivery hours (4 hour minimum)

Delivery instructions (optional)

Wine Buyer Contact Name

Wine Buyer Telephone

Wine Buyer Email

Principal Name/Title

Martine's Wines Sales Rep (optional)

Website (optional)

Upload a copy of your signed resale card (2MB max limit)

To download a Resale Card from the California Department of Tax and Fee Administration please visit www.cdtfa.ca.gov/formspubs/cdtfa230.pdf