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H Cox New Customer Form
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1.
Enter your Company's licensed name and DBA name, if different:
(Required.)
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2.
Enter your Company's address:
(Required.)
*
3.
What county is your Company located in?
(Required.)
Antrim
Benzie
Grand Traverse
Kalkaska
Leelanau
Missaukee
Otsego
Wexford
Multiple locations
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4.
Enter your Company's phone number:
(Required.)
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5.
Enter your beverage buyer's name, phone number, and email address:
(Required.)
6.
Enter the name of your Company's owner:
7.
Upload a picture of your MLCC liquor license, if available:
Choose File
No file chosen
8.
What are your business hours of operation?
9.
If you are a prospective on-premise customer, how would you classify yourself?
Tavern (beverages are primary offering)
Resort/Hotel
Private Club / Service Organizations
Sports Club
Chain Account
Restaurant (food is primary offering)
Bowling Alley
Concessions Stand
Other (please specify)
10.
If you are a prospective off-premise customer, how would you classify yourself?
Convenience Store
Supermarket
Package Store
Mom & Pop Grocery Store
Club
Drug Store
Gas Station
Super Center
Service/Gas Station
Party Store
Other (please specify)
11.
Are you open seasonally?
Yes
No
12.
Do you require scannable price lists?
Yes
No
Unsure
13.
Please provide any delivery limitations or preferences, including receiving hours if applicable.
14.
What package types are you interested in?
Package only
Draft only
Package and draft
