STATE OF NEW JERSEY DEPARTMENT OF LAW AND PUBLIC SAFETY DIVISION OF ALCOHOLIC BEVERAGE CONTROL P.O. BOX 087, 140 EAST FRONT STREET TRENTON, NJ 08625-0087 APPLICATION FOR CONSUMER TASTING PERMIT FOR WHOLESALE LICENSEES [CTW] The initial fee for this Permit is $200.00. An additional fee will be associated with this Permit in the amount of $200.00 for each solicitor listed on the attached Schedule A who will be representing the wholesale licensee at consumer tasting events. During the permit term, new solicitors may be added to Schedule A with the submission of $200.00 per solicitor. Payment should be made in the form of a check or money order payable to the Division of Alcoholic Beverage Control. 1. License term for which Permit is requested: JULY 1, 2_______ TO JUNE 30, 2_______ 2. 3. Name of Licensed Company____________________________________ Address of Licensed Company_________________________________ ____________________________________________________________ 4. Mailing address, if different than above address ____________________________________________________________ ____________________________________________________________ 5. 6. 7. Applicant's 12-Digit License No.____________________________ Contact Name________________________________________________ Contact Phone Number________________________________________ Permittee requests a Consumer Tasting Permit to describe samples of alcoholic beverages to consumers attending educational tasting events sponsored by New Jersey retail licensees, or bona fide non-profit organizations who have been issued a Special Permit for Social Affair. This Permit is annual in term and is renewal concurrent with the renewal of applicant=s wholesale license. Permittee agrees to submit an event notification form to participate in such events at least ten days in advance of the event on the form prescribed by the Director of the Division of Alcoholic Beverage Control. A copy of the form is attached. Name/Title of Authorized Signator________________________________ Please Print Signature___________________________ Dated:______________________ American LegalNet, Inc. www.FormsWorkFlow.com CONSUMER TASTING PERMIT SCHEDULE A NAME OF LICENSED COMPANY: _________________________________________________________ SOLICITOR NUMBER SOLICITOR NAME 04/12 American LegalNet, Inc. www.FormsWorkFlow.com CONSUMER TASTING EVENT NOTIFICATION FORM FOR WHOLESALE LICENSEES HOLDING A CONSUMER TASTING PERMIT Please complete the requested information and fax this form to the Division of ABC at (609) 633-9150 at least 10 days prior to the date of the Consumer Tasting. Be advised all products to be sampled must be brand registered in the State of New Jersey. TO: JOHN COCKLIN SUPERVISING INVESTIGATOR INVESTIGATIVE BUREAU TELEPHONE NO. (609) 984-1984 FAX NO. (609) 633-9150 Please Type or Print Clearly Wholesale Licensee Name_______________________________________________________________ Wholesale License No._________________________________________________________________ Consumer Tasting Permit No.__________________________________________________________ Social Affair Permit No./Plenary Retail Consumption License No.___________________________ Permittee or Licensee Name___________________________________________________________ Date of Tasting______________________________________________________________________ Time_______________________________________________________________________________ Location and Address________________________________________________________________ Solicitor Permit No._____________________Solicitor=s Name:______________________________ Solicitor Permit No._____________________Solicitor=s Name:______________________________ Solicitor Permit No._____________________Solicitor=s Name:______________________________ Solicitor Permit No._____________________Solicitor=s Name:______________________________ Contact Person ______________________________________________________________________ Contact Person Telephone No. (_______)___________________________________________________ Contact Person Fax No. (_______)_______________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ American LegalNet, Inc. www.FormsWorkFlow.com BRAND REGISTRATION NUMBER AND ITEMS TO BE TASTED AT EVENT: Please Type or Print Clearly BRAND REGISTRATION NUMBER: BRANDS: 1.________________________________ 2.________________________________ 3.________________________________ 4.________________________________ 5.________________________________ 6.________________________________ 7.________________________________ 8.________________________________ 9.________________________________ 10.________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ American LegalNet, Inc. www.FormsWorkFlow.com