Customer Paperwork
Name:
Home Address:
Prior address if at current address for less than 5 years:
Telephone Number:
Fax Number:
E-Mail Address:
Website:
Company:
Business Organization:
Mailing Address:
Contact Person/Position:
Liquor License Number & Expiration Date:
Seller's Permit Number (please download Wisconsin Sales and Use Tax Exemption Certificate form S-211 and fax to Purple Feet):
Click here to download Wisconsin Form S-211
Bank Reference (Bank Name/Contact Person/Phone#):
Trade Reference (Company/Contact/Phone#):
