Retailer Portal Supplemental Registration Form

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Retailer Portal Supplemental Registration Form

Please fill out the following information in order to process any Retailer Portal account registration changes.

**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.

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* Indicates required question

Union Beer Account Number *

Please use the primary Union Beer account number associated with your existing Retailer Portal account.

Your answer

First Name *

Your answer

Last Name *

Your answer

Email *

Please use the primary email address associated with your Retailer Portal account.

Your answer

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