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Direct Shipper Permit Application Form. This is a New Hampshire form and can be use in Liquor Commission Statewide.
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Tags: Direct Shipper Permit Application, New Hampshire Statewide, Liquor Commission
DIRECT SHIPPER PERMIT APPLICATION
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Eddie Edwards
Chief
Phone: (603) 271-3521
Fax: (603) 271-3758
eedwards@liquor.state.nh.us
New Hampshire State Liquor Commission
Bureau of Enforcement
Direct Shipping
P.O. Box 1795
Concord, NH 03302-1795
Telephone (603) 271-8543
Mark M. Bodi
Chairman
(603) 271-3132
Patricia T. Russell
Commissioner
(603) 271-3131
Commissioner
(603) 271-3133
PLEASE PRINT OR TYPE
___single Proprietorship
___Partnership
___Corporation ___ LLC
CHOOSE ONE OF THE ABOVE OPTIONS
CORPORATION or LLC NAME ______________________________________________________________
________________________
Bus. Ph. No.
APPLICANT NAME ______________________________________________________________________________________________________
LAST
FIRST
HOME ADDRESS ____________________
NO.
_______________________________________________
STREET
_____________________________________________
CITY
________________________
PO BOX
____________________________________________________
STATE & ZIP
TRADE NAME __________________________________________________________________________________________________________
BUSINESS LOCATION ________________
NO.
_____________________________________________________________________________
STREET
_________________________________________
CITY
___________________________________________________
STATE & ZIP
MAILING ADDRESS _____________________________________________________________________________________________________
NAME
NO. & STREET
_____________________________________________
CITY
___________________________________________________
STATE & ZIP
INTERNET ADDRESS http://www. ________________________________________EMAIL ADDRESS ____________________________________
List below or on the back of this form, the names and addresses of the business owners, partners, corporate officers, or LLC
members, as appropriate.
By Filing this application, I agree to operate in NH under the requirements of RSA 178:27, Liquor Rules Chapter 1100, and all
other applicable NH Laws and Liquor Rules, and to file required monthly tax reporting documents and fees.
By signing this application, I acknowledge for ________________________________(Business name) that all information
provided is true and correct, and that I agree to meet the NH operating conditions specified above. You must be an owner,
partner, corporate officer, or LLC member to sign.
_____________________________________ Signature
_________________________________________ Title
Mail completed application for a permit to:
NH Liquor Commission
Bureau of Enforcement
Attn: Direct Shipping
PO Box 1795
Concord NH 03302-1795
Attach to this application a copy of your state alcohol license(s), and a copy of your registration
with the Secretary of State to do business in your state of domicile.
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* * * Application Requirements * * *
1. Complete and return the State of New Hampshire Direct Shipper Application.
2. In order to obtain a direct shipper permit your company must hold a valid liquor license from your
state of domicile as an alcohol manufacturer, importer, wholesaler or retailer. A copy of that liquor
license must be submitted with your application for a direct shipper permit.
3. In order to obtain a direct shipper permit you must provide a copy of your registration from your
state of domicile Secretary of State or from the appropriate governing authority.
A.
B.
C.
D.
Single Proprietorship – Fictitious Business Name
Partnership – Fictitious Business Name
Corporation – Articles of Incorporation, Certificate of Registration or Certificate of Authority
LLC – Articles of Organization, Certificate of Registration or Certificate of Authority
4. A. Prior to January 1, 2001, enclose a check for $228.00.
B. Effective January 1, 2001, there is no fee required for this permit.
* * * Permit Restrictions * * *
1. May ship up to 60 individual container of not more than one liter each of liquor & wine to any one
licensee in New Hampshire or to any consumer or consumer’ address in New Hampshire in any
s
calendar year. (RSA 178:27, III)
2. May ship up to 27 gallons of beer or beverage in individual containers of not more than one liter
to any consumer’ address in New Hampshire in any calendar year. No direct shipper shall ship
s
beer or beverage to a New Hampshire licensee. (RSA 178:27, IV)
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3. All direct shippers must file with the New Hampshire Liquor Commission on or before the 10 of
the following month a Direct Shipper tax report (regardless of activity) showing all shipments of
alcohol into New Hampshire with copies of invoices attached. Please make the check payable to
the State of New Hampshire Liquor Commission in the amount of 8% of the total retail price of all
shipments of alcohol into the State of New Hampshire. (RSA 178:27,V)
4. All consumers must be 21 years of age or older. (RSA 178:27, II)
5. All packages must be clearly marked, “
Alcoholic Beverages, adult signature (over 21 years of
age) required”
.
(RSA 178:27, II)
6. Any person holding a direct shippers permit under this section who ships liquor, wine & beer to a
person under 21 years of age, shall be guilty of a class B felony and shall have such permit
permanently revoked. (RSA 178:27, VII)
7. No direct shipper may ship to a dry town. The dry towns are Brookfield, Ellsworth, Landaff,
Monroe and Sharon.
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