Application for Retailers Buyers Card For Liquor And Wine Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
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DEPARTMENT OF PUBLIC SAFETY ALCOHOL AND GAMBLING ENFORCEMENT DIVISION 445 Minnesota Street Suite 222 St. Paul, MN 55101 Phone (651) 201-7507 TDD (651) 282-6555 Fax (651) 297-5259 CARD NUMBER (Office Use Only) PLEASE RETURN THIS APPLICATION WITH FEE $20.00 ISSUING AUTHORITY TYPE CODE BUYER'S CARD EXPIRES IDENTIFICATION # APPLICATION FOR RETAILER'S (BUYER'S) CARD FOR LIQUOR AND WINE PRINT NAME OF LICENSEE (AS SHOWN ON LICENSE BUSINESS NAME (DBA) BUSINESS ADDRESS COUNTY BUSINESS PHONE CITY, STATE, ZIP CODE AUTHORIZED SIGNATURE PS 9135 (12/09) American LegalNet, Inc. www.FormsWorkFlow.com