Bureau of Alcoholic Beverages and Lottery Operations Division of Liquor Licensing & Enforcement 8 State House Station, Augusta, ME 04333-0008 Tel: (207) 624-7220 Fax: (207) 387-3434 Email inquiries: MaineLiquor@maine.gov LICENSED MAINE WHOLESALERS REQUEST FOR: BEER & WINE TASTE TESTINGS License No: ____________ Legal Name: ___________________________________________ D/B/A Name: __________________________________________________________________ Mailing Address: _______________________________________________________________ Town/City: _______________________ State: _______________ Zip Code: ___________ Telephone: __________________________ Fax: ______________________ Email (please print): _____________________________________________________________ Date of Event: ________________________ Time ­ From: __________ To: __________ Number of Persons Attending: _______________ Inside Outside (Outside need diagram) Title and Purpose of Event: _______________________________________________________ Location of Event: ______________________________________________________________ Physical Address: ______________________________________________________________ Town/City: __________________________ State: ________________ Zip Code: _________ Contact Person: _______________________Telephone Number: ________________________ Email address of contact person: ___________________________________________________ _____________________________________ Signature of Licensee or Corporate Officer _____________________________________ Print Name of Licensee or Corporate Officer ________________________ Date PLEASE ATTACH List of vendors participating List of Employees serving alcohol FOR USE ONLY BY DIVISION OF LIQUOR LICENSING & ENFORCEMENT RESTRICTIONS: DIVISION USE ONLY License No: Class: Approved Not Approved By: Wholesalers Beer Wine Tasting Rev 9/2016 American LegalNet, Inc. www.FormsWorkFlow.com