OREGON LIQUOR CONTROL COMMISSION LICENSE APPLICATION REQUEST Complete the questions below to help OLCC determine the types and numbers of forms you will need to file your license application. Please print or type. INFORMATION ABOUT THE APPLICANT Applicant Name: __________________________________________________________________________ Mailing Address: __________________________________________________________________________ Phone Number: (_________)__________________________ How do you plan to operate the business? (check one) Individuals Corporation Limited Liability Company Other - (specify) ______ ________________________ How many people will share ownership in this business? _______ Will you have a manager who is not an owner? _______ INFORMATION ABOUT THE BUSINESS Are you buying an existing business _____ or starting a new business? ______ (check one) If you are buying an existing business, do they currently sell alcohol? _______ Is this business a franchise? _______ Current Trade Name ______________________________________________________________________ Your New Trade Name ____________________________________________________________________ Business Location Address _________________________________________________________________ Type of License desired Sell liquor, beer, and wine, by the drink, and offer food service. Sell beer and wine for consumption at the business. Cater food and alcohol to private groups at other locations. Sell beer and wine to go. Other - Please describe. ______________________________ Action New Business Change of ownership Greater Privilege Additional Privilege Other____________________ Have you completed OLCC Law Orientation?______ If so, when? __________________________________ Have you completed an Alcohol Server's Education Class?________ If so, when? _____________________ What is your target date to open the business? ________ Person OLCC can contact about this request: ____________________________ Date of Request: ________ WHEN COMPLETE, MAIL THIS FORM TO: OLCC, PO BOX 22297, MILWAUKIE OR, 97269-2297 9079 SE McLoughlin Blvd. Portland, OR 97222-7355 Mailing address: PO Box 22297 Milwaukie, OR 97269-2297 Phone: (503) 872-5070 Toll Free: 1-800-452-OLCC (6522) www.olcc.state.or.us (rev. 05/03) American LegalNet, Inc. www.FormsWorkflow.com