Application For Brand Label Registration
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Application For Brand Label Registration Form. This is a Connecticut form and can be use in Department Of Consumer Protection Statewide.
Tags: Application For Brand Label Registration, Connecticut Statewide, Department Of Consumer Protection
For Official Use Only
LBD-01 Rev 9/09
STATE OF CONNECTICUT
Department of Consumer Protection
Liquor Control Division
165 Capitol Avenue
Hartford, CT 06106
Telephone: (860) 713-6200
Web Site: www.ct.gov/dcp
APPLICATION FOR BRAND LABEL REGISTRATION
INSTRUCTIONS :
Please print clearly or type. Complete application and submit to the address above for each brand label to be registered. This application
must be accompanied by a check and/or money order made payable to “Treasurer, State of CT." See fee schedule below.
Type or print legibly the Company Name and Address
Fee Schedule: (fee applies for a 3-year period)
Company
Name
1). Registrant located in Connecticut: $200.00 per label
2). Registrant located Out-of-State:
$200.00 per label
3). Manufacturer located in Connecticut: $15.00 per label
Address
If the Company Name on the label differs from that of the Registrant,
check ( ) the appropriate box for each brand label to be registered.
Item
No
BRAND NAME
(as it appears on the label)
Unimerc
Brand Code
DBA
or
Trade
Name
Authorized
Agent
Attach
Authorization
1
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