Appointment Of Vendors Designated Agent
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Appointment Of Vendors Designated Agent Form. This is a Michigan form and can be use in Liquor Control Commission Statewide.
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Tags: Appointment Of Vendors Designated Agent, LC 133, Michigan Statewide, Liquor Control Commission
Michigan Department of Licensing and Regulatory Affairs
Liquor Control Commission (MLCC)
Constitution Hall - 525 W. Allegan, Lansing, MI 48933
Mailing Address: PO Box 30005, Lansing, MI 48909
Toll Free (866) 813-0011 • www.michigan.gov/lcc
APPOINTMENT OF VENDOR'S DESIGNATED AGENT
FOR AUTHORIZATION OF PURCHASE ORDERS FOR LIQUOR
The purpose of this form is for the vendor of spirits to designate to the Michigan Liquor Control Commission an agent for
the authorization of purchase orders for liquor. The vendors' designated agent should be available at the email address
and facsimile number indicated to receive the Commission's preliminary purchase requirements.
MLCC Vendor Number:
Vendor of spirits (Company Name):
Street Address:
City, State, Zip Code:
Email Address:
Facsimile number:
Telephone Number:
(
)
(
)
Vendors of spirits will receive a purchase order from the Liquor Control Commission daily for each day their products are
ordered by the Commission's licensees. The above named vendor of spirits to the Michigan Liquor Control Commission
(MLCC) authorizes the following agent as its representative to accept, in whole or in part, orders to purchase spirits stored
at Authorized Distribution Agents' facilities and to sell those spirits to the Commission. The vendor of spirits agrees that
MLCCCONFIRM@MICHIGAN.GOV within two hours of receipt of
its designated agent shall contact the Commission at
the order if the order is refused, in whole or in part, or the Commission's entire order shall be deemed to have been
accepted.
DESIGNATED AGENT
Name:
Street Address:
City, State, Zip Code:
Email Address:
Facsimile number (to be used if email is undeliverable):
Telephone Number:
(
(
)
)
This appointment of Vendor's Designated Agent may be amended by the vendor upon notice to the Commission, and with
the submission of a new appointment of Vendor's Designated Agent form.
Signature of Vendor or authority who
assigns designated agents:
Printed Name:
Date:
Title:
LC-133 (Rev. 06/14)
AUTHORITY: MCL 436.1201
COMPLETION: Mandatory
PENALTY: No Purchases
LARA is an equal opportunity employer/program.
Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities.
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