Retailers Sign-Up The signup form for Retailers Company InformationCompany NameNumber of Active AGLC Licenses or LocationsNumber of AGLC Licenses or Locations Awaiting ApprovalHead Office Address Street Address City Postal Code Website* Yes, we want to have your company name and logo displayed on the ACC website as members of the association.Corporate LogoPlease provide your store logo for display on our website. Primary Contact InformationPlease let us know who our primary contact will be for your company. This person will be given your voting authority within the ACC, and receive all communications from the association. The primary contact can be changed whenever and as often as you want. Name* First Last Title / Position*Phone*Email* I agree to my contact information being shared with other members of the ACC and displayed in the ACC members directory.