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 SUPPLIER REPRESENTATIVES [CTS] 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 supplier representative who possesses an ownership interest in an out-of-state winery, brewery or distillery that does not hold a New Jersey Wholesale License. 1. Term for which Permit is requested: JULY 1, 2_______ TO JUNE 30, 2_______ 2. Name of Supplier____________________________________________ 3. Address of Supplier_________________________________________ ____________________________________________________________ 4. Mailing address, if different than above address ____________________________________________________________ 5. Contact Name________________________________________________ 6. Contact Phone Number________________________________________ 7. Supplier’s Federal Permit No._______________________________ 8. Names of Supplier Representatives to attend events in New Jersey: 1. _______________________________________________________ 2. _______________________________________________________ 3. _______________________________________________________ 4. _______________________________________________________ 5. _______________________________________________________ 6. _______________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com Permittee requests a Consumer Tasting Permit to describe and pour 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 renewable on July 1st of each year. 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 Signature: _____________________________________ (Please Print) _____________________________________ Signature 01/08 American LegalNet, Inc. www.FormsWorkflow.com CONSUMER TASTING EVENT NOTIFICATION FORM FOR OUT-OF-STATE SUPPLIER LICENSEES HOLDING A CONSUMER TASTING PERMIT Please complete the requested information and fax this request to the Division of ABC at (609) 292-0691 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: DIANE M. WEISS EXECUTIVE ASSISTANT-IN-CHARGE-OF LICENSING BUREAU TELEPHONE NO. (609) 292-0322 FAX NO. (609) 292-0691 Please Type or Print Clearly Supplier Licensee Name_______________________________________________________________ Supplier License No._________________________________________________________________ Consumer Tasting Permit No. For Supplier Representatives_________________________________ Social Affair Permit No./Plenary Retail Consumption License No.___________________________ Permittee or Licensee Name___________________________________________________________ Date of Tasting______________________________________________________________________ Time_______________________________________________________________________________ Location and Address________________________________________________________________ Supplier Representative Name_______________________________________Interest:_____________ Supplier Representative Name_______________________________________Interest:_____________ Supplier Representative Name_______________________________________Interest:_____________ Supplier Representative Name_______________________________________Interest:_____________ Contact Person ______________________________________________________________________ Contact Person Telephone No. (_______)___________________________________________________ Contact Person Fax No. (_______)_______________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ Supplier Representative Name__________________________Interest:_______________________ 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