BUYER REGISTRATION FORM – PALLET PORTAL

BUYER

Register to discover curated wines for your portfolio.

Buyer Registration Form – Pallet Portal

Please fill out this form to be approved as a member of Pallet Portal.

First Name

Sur Name

Title

Company

Web

Phone

Email

ABOUT OUR COMPANY

Wine Industry Buyer Category (check all that apply)

Importer

Distributor

Retailer (off-premise)

Restaurant/Bar (on-premise)

Broker

We have licenses in these states (please list):

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