Wholesale Customer Intake

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Wholesale Customer Intake

Complete the form below to apply for a Vine Bar wholesale account. Once approved, you’ll be able to place wine orders by text message and receive automated order confirmations. A member of our team will follow up within 1–2 business days.

Wholesale Intake

X/Twitter

This field is for validation purposes and should be left unchanged.

Business Name(Required)

Contact Person(Required)

Your Role/Title

Default Delivery Person / Receiving Contact

Mobile Number(Required)

Email(Required)

Delivery Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Delivery Instructions

SMS Odering

Mobile Number for SMS Ordering(Required)

Signature(Required)