Retailer Portal Application

Retailer Portal Application

*Current Customers Only*

Retail Portal Website Link

TABC License*

Yes

No

Pending

Account Number*

Business Name (DBA)

TABC License #

TABC License Expiration Date

AIMS License Type

Select or enter value

TABC AIMS #

Street Address

City

Zip Code*

State

Texas

Arkansas

Buyer / Agent Full Name

Phone Number*

Business #

Phone

Cell Phone #*

Phone

Email Address*

Website

Application Comments From Form

Licensee or Officer Portal Access Approval*

Approve Portal Access for Buyer or Agent

Licensee Full Name*

submitted by:

Send me a copy of my responses

Privacy Notice|Report Abuse