FORM C-801 (5/2009) NOTICE OF DEFAULT Wholesaler Or Local Distributor Permittee To Retailer, Mixed Beverage, or Private Club Permittee Note: All sections of this form must be filled out completely with correct information & signature of representative. PERMIT NUMBER: DATE: PLEASE (X) THE FOLLOWING DELIVERY PERIOD: 1 – 15 OR 16 – 31 TRADENAME: OWNER: LOCATION ADDRESS: AMOUNT UNPAID: NOTE: Pursuant to Section 102.32 of the Texas Alcoholic Beverage Code and Rule 45.121, notice is hereby given that you are in default for the payment of purchased liquor. A copy of this notice must be submitted to TABC by one of the following options; email credit.law@tabc.state.tx.us, fax 512-206-3329, or at the address listed below. Texas Alcoholic Beverage Commission P.O. Box 13127 Austin, TX 78711 Name of Wholesaler or Local Distributor Permittee Permit Number Address Representative’s Signature Title NOTICE TO RETAILER, MIXED BEVERAGE OR PRIVATE CLUB PERMITTEE: Section 102.32 of the Texas Alcoholic Beverage Code provides that a retailer, Mixed Beverage or Private Club Permittee who is in arrears for the payment of liquor may not purchase alcoholic beverages from any Wholesaler or Local Distributor Permittee. And whereas if the same Permittee owns more than one licensed premise and his name appears on the delinquent list, no sales may be made to any of the premises operated by such Permittee. If non-payment for the above purchases is the result of a dispute as to amount, quantity, or quality, a statement should be filed immediately with the Texas Alcoholic Beverage Commission. American LegalNet, Inc. www.FormsWorkFlow.com