Capitol Husting Co.

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Local: 414-353-1000
Fax: 414-353-0768
Address:
  12001 W Carmen Ave
  Milwaukee, WI, 53225

New Customer Application

Downloadable New Customer Application (PDF)
Right-click, then click "Save As" to download a copy

Trade Name

This Business is (Please Check One)

Liquor Licensee

Agent Name if Licensee is not an Individual

Contact (or Buyers) Name

Please check what type of legal entity the business is




If business is a Sole-Proprietorship, please type the name and address of owner:

If business is a Partnership, Corporation, LLC, or LLP type its legal name:

If the business is not a Sole-Proprietorship, please type the name(s) and home address(es) of the officers:

Business Address
City
State
Zip

Business Phone

Business Fax

Federal Tax ID #

Wisconsin Sellers Permit #

Liquor License Renewal (MM/DD/YYYY)

License Number

Fill in the name of the municipality who is issuing the liquor license

Mailing Address - if different from delivery address Name

Address

City
State
Zip

Account Type (please check one) On Premise Accounts








Off Premise Accounts







Is this account part of a chain?
If yes, the name of the chain:

Account Ethnicity (please check one)










Account Classification (please check one)

Does the account want invoices split?
If yes, please check the appropriate split below
(the "/" splits the invoice, the "&" includes on any invoice)





Specific Delivery Instructions:

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