Pay-Per-Fill Application Form

Thank you for your interest in the Keg Logistics/North Keg Pay-Per-Fill Program.

Please fill out the form below to help us better understand your sales history and distributor network. Please provide as much detailed information as possible.

Company Details

Company Name*

Business Type (LLC, S Corp, C Corp, etc.)*

First Name of Contract Signer*

Last Name of Contract Signer*

Email of Contract Signer*

Job Title of Contract Signer*

Phone # of Contract Signer*

Shipping Address

Ship to Brewery Name or Contract Facility*

Shipping Address*

Shipping City*

Shipping State/Region*

Shipping Postal Code*

Shipping Contact*

Shipping Contact Email

Shipping Contact Phone #*

Liftgate Needed for Delivery?*

Accounting & Billing

Accounting First Name*

Accounting Last Name*

Accounting Email*

Accounting Phone #*

Billing Company Name*

Billing Address*

Billing City*

Billing State*

Billing Zip Code*

Brewery Fill Data

Brewery Annual Production (BBLS)*

Annual Production Volume in Kegs (%)*

1/2 BBL Kegs Owned/Renting*

1/6 BBL Kegs Owned/Renting*

50 Liter Kegs Owned/Renting*

1/4 BBL Kegs Owned/Renting*

Would you like to sell any of your currently owned kegs?

Number of 1/2 BBL Kegs Sold Last 12 Months*

Number of 1/6 BBL Kegs Sold Last 12 Months*

Number of 1/4 BBL Kegs Sold Last 12 Months*

Number of 50 Liter Kegs Sold Last 12 Months*

Taproom Kegs Sold

1/2 BBLS Sold*

1/6 BBLS Sold*

1/4 BBLS Sold*

50 Liters Sold

Distributor 1

Name*

City*

State*

1/2 BBLS Sold Monthly*

1/6 BBLS Sold Monthly*

1/4 BBLS Sold Monthly*

50 Liters Sold Monthly*

Distributor 2

Name

City

State

1/2 BBLS Sold Monthly

1/6 BBLS Sold Monthly

1/4 BBLS Sold Monthly

50 Liters Sold Monthly

Distributor 3

Name

City

State

1/2 BBLS Sold Monthly

1/6 BBLS Sold Monthly

1/4 BBLS Sold Monthly

50 Liters Sold Monthly

Distributor 4

Name

City

State

1/2 BBLS Sold Monthly

1/6 BBLS Sold Monthly

1/4 BBLS Sold Monthly

50 Liters Sold Monthly

If you have more than 4 distributors, please email the additional details to us separately.

By clicking submit, you consent to allow Keg Logistics to store and process the personal information submitted above to provide you the services requested.