Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Cooperative Purchasing Group Application Form. This is a New Jersey form and can be use in Division Of Alcoholic Beverage Control Statewide.
Loading PDF...
Tags: Cooperative Purchasing Group Application, New Jersey Statewide, Division Of Alcoholic Beverage Control
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 086250087
COOPERATIVE PURCHASING GROUP APPLICATION FOR 20082009
CoOp Number ___________________________________________________
Cooperative Group Name__________________________________________
Mailing Address: c/o___________________________________________
Street_____________________________________________________
City_______________________________ Zip Code_______________
THE REASON FOR THIS APPLICATION IS:
_____CREATE A NEW COOP
_____DELETE AN EXISTING MEMBER
_____RENEW EXISTING COOP NUMBER___________
_____ADD A NEW MEMBER
The fee enclosed with this application is $____________________.
Payment should be made in the form of a check or money order
payable to the Division of Alcoholic Beverage Control.
ONE CHECK PER COOP – $15.00 PER MEMBER
The above group hereby petitions the Director of the Division of
Alcoholic Beverage Control to issue a Special Permit which
reflects the changes in membership requested above.
Name of CoOp Officer______________________________________
Signature______________________________________
Title______________________________________
CoOp Officer Phone Number______________________________________
Date______________________________________
American LegalNet, Inc.
www.FormsWorkflow.com
CONTACT PERSON IF OTHER THAN COOP OFFICER:
Name:_______________________________________
Telephone No.:_____________________________________________
NOTE:
This form must be accompanied by a Licensee Information Form
completed by each licensee wishing to begin or end membership
with the applicant cooperative group. [N.J.A.C. 13:226.1(b)1.]
NEW COOPERATIVES are required to provide their COOPERATIVE
AGREEMENT endorsed by each cooperative member. [N.J.A.C. 13:2
26.1(b)2.]
An original signed copy of this form must be submitted each time
a member of the Cooperative Purchasing Group is added or
deleted.
04/08
American LegalNet, Inc.
www.FormsWorkflow.com
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 086250087
INDIVIDUAL RETAIL LICENSEE INFORMATION FORM
This application must be completed in full by EACH
cooperative member. It should be submitted to the Division of
Alcoholic Beverage Control in company with a Cooperative Group
Application form which has been completed and signed by an
officer of the Cooperative Group. Each member should submit a
fee of $15.00 in the form of a check or money order payable to
the Division of A.B.C.
ACTION REQUESTED: (Check One)
______ Renew Membership in Cooperative Group ______________
______ New Membership in Cooperative Group ______________
______ Delete Membership in Cooperative Group ______________
License Name____________________________________________________
12Digit License Number_________________________________________
Address of Licensed Premises:
Street__________________________________________________
City _____________________________ Zip_________________
Telephone No. ( )_________________
Signature of Licensee___________________________________
Print Name___________________________________
Title____________________________________
Date____________________________________
Please note, this application must be signed by licensee if an
individual; by a general partner if a partnership, general or
limited; or by a corporate president or vice president if a
corporation.
04/08
American LegalNet, Inc.
www.FormsWorkflow.com