CONSUMER TASTING EVENT NOTIFICATION FORM FOR WHOLESALE LICENSEES HOLDING A CONSUMER TASTING PERMIT Please complete the requested information and fax this form 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 Wholesale Licensee Name_______________________________________________________________ Wholesale License No._________________________________________________________________ Consumer Tasting Permit No.__________________________________________________________ Social Affair Permit No./Plenary Retail Consumption License No.___________________________ Permittee or Licensee Name___________________________________________________________ Date of Tasting______________________________________________________________________ Time_______________________________________________________________________________ Location and Address________________________________________________________________ Solicitor Permit No._____________________Solicitor=s Name:______________________________ Solicitor Permit No._____________________Solicitor=s Name:______________________________ Solicitor Permit No._____________________Solicitor=s Name:______________________________ Solicitor Permit No._____________________Solicitor=s Name:______________________________ Contact Person ______________________________________________________________________ Contact Person Telephone No. (_______)___________________________________________________ Contact Person Fax No. (_______)_______________________________________________________ 1 American LegalNet, Inc. www.FormsWorkflow.com Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ Solicitor Permit No.________________Solicitor=s Name:______________________________ 2 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.________________________________ ____________________________________ 3 American LegalNet, Inc. www.FormsWorkflow.com