Please print and fill-out the required ST-120 form and then upload when completed.

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PDF Scan/ JPG Photograph & Upload


For Credit terms, please list three references only.

I acknowledge that the terms offered by Dana Distributors, Inc. are in accordance with the terms set forth by the NY State Liquor Authority.


I agree to pay interest at a rate of 1.5% per month (18% per annum) for all invoices past due, and all reasonable costs of collection, including attorney’s fees, in the event of my failure to pay. In consideration of the receipt of services by said firm, we the undersigned do hereby jointly and severally guarantee the payment to said firm. This is your authority to charge 1.5% per month (18% per annum) on all past due amounts. I/We the undersigned do also hereby agree that if default of payment shall be made by the said debtor’s account, past or future, in accordance with the terms of credit, that we will make the said payment or any balance due thereon, and do jointly guarantee the payment of the said account any balance due on same, plus interest and cost of collection fees if necessary. I/We hereby waive notice of non-payment of the said account by the said debtor and notice of failure of collection of the same.