Retailer Portal Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

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 report more than 5 account locations, please contact your customer service representative.

Sign in to Google to save your progress. Learn more

* Indicates required question

Do you have an existing account with Craft New Hampshire? *

Yes

No

First Name *

Your answer

Last Name *

Your answer

Email *

Your answer

Phone number *

Your answer

Sales Representative's Name

(If you already have an account with this distributor. Leave blank if unknown.)

Your answer

Does your account operate on a seasonal basis? *

Yes

No

Next

Clear form

Never submit passwords through Google Forms.

This form was created inside of L. Knife & Son, Inc.. Report Abuse