Become a Stockist

Online Credit Application Form for Stockists
Interested in becoming a Fourth Wave Wine stockist? Please complete the below application form and a representative in your area will be in touch soon.

Address Details

Delivery Address
(Your preferred business delivery address)
Postal Address
(if different from delivery address)

Accounts Contact Details


Payment Details

Payment Terms
All invoices are due for payemnt on 15th of the following month. Please provide your credit card details below if you would like us to co-ordinate the timing of your payments to ensure you receive our 2.5% on-time payment discount when paying on time. You will recieve a payment receipt from our office at the time of payment. Alternatively, call 1300 778 047 to provide your credit card details.

Trade References

A minimum of 3 trade references are required to open an account with Fourth Wave Wine. NB: COD Account - no trade references required)
Trade Reference 1
Trade Reference 2
Trade Reference 3


Agreement and Execution


Personal Guarantee