MONARCH BEVERAGE CO. & WORLD CLASS BEERNew Account Requirements

Be sure to submit the following information: Completed New Account Setup Form Copy of Indiana ATC issued Retailer Permit or Letter of Authority Copy of completed General Sales Tax Exemption Certificate (IN Form ST-105) Copy of Registered Retail Merchant Certificate

You may submit this information using one of the following methods:Fax: (317) 612-3271Email: licensing@monarch-beverage.comMail: Monarch Beverage Company

Please call with questions:Phone: (317) 612-1310 x1700

Attn: New Accounts9347 E. Pendleton PikeIndianapolis, IN 46236

1.2.3.

4.

Completed by:CUSTOMER INFORMATION

Buyer InformationName: Email:Account InformationCorporation/License Name:DBA:Delivery Address:Delivery City:Account Phone:Owner InformationName:DBA:Mailing Address:Mailing City:Phone:Email:

LICENSING INFORMATIONIndiana ATC Issued PermitPermit Number (i.e. xx1234567)Expiration Date:Indiana Registered Retail Merchant’s CertificateTIT Number( 10-digits):LOC Numbers (3-digit):Indiana Registered Retail Merchant’s CertificateTIT Number( 10-digits):LOC Numbers (3-digit):

DELIVERY INFORMATIONBusiness Operation HoursOpen:Preferred Delivery Window

Requested Delivery DayCheck One:

FOR INTERNAL USE ONLYDelivery DayCheck OneRep InformationMonarch Beer Sales Rep:Monarch Wine Sales Rep:World Class Beer Sales Rep:A/R Rep:Completed by:Comments: Draft Beer (Y/N)

Please allow 2 business days for the account to be setup.

NEW ACCOUNT SETUPFax: (317) 612-3271

licensing@monarch-beverage.com

Phone:

Delivery Zip Code:Account Fax:

Mailing Zip Code:Fax:

Permit Type:

Close:

Call Days:Call Days:Call Days:A/R Terms:Date:

Market Type:

Date: Phone:

Mon. Tue. Wed. Thur. Fri. Sat. Sun

Mon. Tue. Wed. Thur. Fri. Sat. Sun

Mon. Tue. Wed. Thur. Fri. Sat. Sun

Mon. Tue. Wed. Thur. Fri. No Preference

Open: am pmClose: am pm

Open: am pmClose: am pm

Mon. Tue. Wed. Thur. Fri. No Preference