Ruby Street Brewing, LLC - AUTHORIZED DEALER SETUP FORM

Note: Ruby Street Brewing only sells products to established brick and mortar home beer brewing supply retail stores. Upon submitting this application, we may reach out to you for additional information to determine authorized dealer eligibility.

Company Name

Federal Tax ID (EIN)

Distributor?

Retail Store?

Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Name

First Name

Last Name

Your Title

Your Email Address

Phone Number

(###)

###

####

Website

http://

When Did Your Business Launch?

MM

DD

YYYY

Ruby Street Brewing, LLC - AUTHORIZED DEALER SETUP FORM

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