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Wholesale Customer Information Form.

Please check one:
New Customer:
Update or Change Information:
Customer Number:
(if new customer, leave blank)
Customer Name:
Street Address:
City:
State:
Zip Code:
Your Phone:
Your Email:
Contact Name(s):
Liquor License #:
License Expiration Date:
State Tax ID Number:
Attach Liquor License:
Delivery Instructions:



Dominican Habitat, LLC is a Importer / Wholesaler / Distributor of alcohol and tobacco products.

You must be at least 21 yrs. of age to purchase any tobacco products from Dominican Habitat.com by law. By placing an order, you are in agreement that you are of legal age, if you are not of legal age Dominican Habitat.com will refuse service.

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