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Account Registration
Register to be considered for an Epiphany Craft Malt account. With an account you will be able to view inventory, prices, and order through our store.
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* Indicates required question
Name of Business
*
Your answer
First Name
*
Your answer
Last Name
*
Your answer
Job Title:
*
Your answer
Federal Tax ID # / Employer ID #
*
Your answer
Buyer Email:
*
Your answer
Buyer Phone
*
Your answer
Accounting Email:
*
Your answer
Accounting Phone:
*
Your answer
Business Type
*
Choose
Brewery
Distillery
Distributor
Other
Billing Address
Address 1
*
Your answer
Address 2
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Shipping Address
(If different from Billing Address)
Address 1
Your answer
Address 2
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Will your deliveries require a liftgate?
*
Choose
No
Yes
I agree to the "Epiphany Craft Malt Account Registration Terms and Conditions"
*
Yes
Required
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