Wholesale Application

Interested in stocking Cofield Wines? Complete the form below to apply for a wholesale account. Once your application has been reviewed, we’ll be in touch to confirm your account and provide our current Wholesale Price List.

Registered Business Name

Trading As

ABN

Liquor License Number

Delivery Address (and any delivery instructions)

Business Phone Number

Number of years in business?

Ordering Contact Name

Ordering Contact Email

Ordering Contact Phone

Accounts Contact Name

Accounts Contact Email

Accounts Contact Phone

Trade Reference #1

Trade Reference #2

Wholesale Account Terms & Conditions

Please review the Cofield Wines Wholesale Account Terms & Conditions before submitting your application.

View Wholesale Account Terms & Conditions

Acceptance of the Wholesale Terms Conditions

Name

Date

Wholesale Application

Wholesale Application

Wholesale Account Terms & Conditions

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