Wine Shipper Brand Listing
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Wine Shipper Brand Listing Form. This is a North Carolina form and can be use in Alcoholic Beverage Control Commission Statewide.
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Tags: Wine Shipper Brand Listing, North Carolina Statewide, Alcoholic Beverage Control Commission
North Carolina Alcoholic Beverage Control Commission
Wine Shipper Brand Listing
This form must be completed and submitted with the initial Wine Shipper Permit Application. There after, submit with the
addition or deletion of brands.
Page
Please print or type.
Brand Name
Add
Remove
Permittee Name:
Presently being
shipped into NC indicate Yes or No
of
NC Wholesaler
Notified - Indicate
Yes
No
Permit Number:
Permittee Address:
Permittee Phone Number:
Email Address:
Name of Common Carrier:
Approved by The Commission:
Yes
No
OATH OF APPLICANT
I certify as required by NCGS 18B-902(a) and (c)that this document is true, correct and complete to the best of my knowledge.
Printed Name and Position of Authorized Official:
Signature of Authorized Official:
Date
NC Wine Shipper Brand Listing - 8/2003
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