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Retailer Portal Registration Form
Please fill out the following information in order to process your Retailer Portal account registration.

**FOR THE USE OF STATE ALCOHOLIC BEVERAGE RETAIL LICENSE HOLDERS ONLY**

Please Note: If you would like to add more than 5 account locations, please contact your Sales Representative.
Do you have an existing account with Union Beer Distributors? *
If yes, what is your Union Beer Account Number?
First Name *
Last Name *
Email *
Phone number *
Sales Representative's Name
(If you already have an account with Union Beer. Leave blank if unknown.)
Does your account operate on a seasonal basis? *
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