FORM C-222 (10/2002) ORDER FORM TRADE NAME: LICENSE/PERMIT NUMBER: MAILING ADDRESS: CITY: ZIP CODE: PHONE NUMBER: Please check the appropriate box for the type of form(s) needed and circle the amount required: FORM AMOUNT FORM C-230 (Distributors Report) 6 12 24 FORM C-233 (Wholesalers Ale & Malt Liquor Report) 6 12 24 FORM C-210 (Wholesalers Report) 6 12 24 FORM C-215 (Winery / Wine Bottler Report) 6 12 24 Please return this form to the T.A.B.C., PO Box 13127, Austin, TX 78711-3127 or fax it to (512) 206-3321. **REPORT FORMS ARE AVAILABLE VIA OUR WEBSI TE AT WWW.TABC.STATE. TX.US** American LegalNet, Inc. www.FormsWorkflow.com