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Retailer Portal Request
It may take up to 2 business days for us to verify and create your account.
With any questions, please contact the office at 570-343-2454.
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* Indicates required question
Retailer Account Name
*
Your answer
Liquor License Number
If applicable.
Your answer
Retail Account Number
*
This is the 5 digit code located on an invoice (i.e.: 12345)
Your answer
Delivery Address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Requestor Name
*
(First and Last Name)
Your answer
Preferred Contact Number
*
Your answer
Email Address
*
Your answer
LTV Sales Representative Name (if known)
Your answer
Enter 1234 to make sure you are human.
*
Your answer
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