Thank you for your interest to become one of our retail partners! 
You may print this form, complete it and fax it to 719-488-1290. Once your application is approved, we will email you our retailer kit and then you will be able to purchase any of our products at Keystone pricing. Our minimum opening order is $249.00. 


BUSINESS NAME: __________________________________________________________________________________________


ADDRESS: ________________________________________________________________________________________________


CITY:  _______________________________________  STATE: ___________________  ZIP:  _____________________________


PHONE: ___________________________________________  FAX: __________________________________________________


 OWNERSHIP:     INDIVIDUAL  ________________  PARTNERSHIP  ________________  CORPORATION  __________________

 FEDERAL TAX ID NO.: ______________________________________ 

NON PROFIT: ______________________________________________ REGISTRATION#:_________________________ 

PURCHASES AUTHORIZED BY: _______________________________________________________________________________

 CONTACT EMAIL: ___________________________________________________________________________________________

X  ______________________________________________________    Date:__________________________________

      Authorized Signature & Title                


 Note: To preserve the value of our brand, Retail partners must abide by our Minimum Advertised Price (MAP) policy which states you may not advertise our products below 30% off MSRP. You may sell our products at any price you wish; however, you may not advertise our products for sale below the MAP percentage. MAP violations may result in termination of your wholesale status.


Hummingbird Vineyard, Inc., 14104 Tern Dr., Colorado Springs, CO 80921

*Phone (719) 337-4011    *Fax (719) 488-1290    *Email:

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