Licensing and Regulation Division PO Box 43098 Olympia WA 98504-3098 360-664-1600 Fax 360-753-2710 www.liq.wa.gov License No ____________________________________ Trade Name ___________________________________ UBI No _______________________________________ ADDED ACTIVITIES FOR BEER-WINE SPECIALTY SHOPS & GROCERY STORES Do you want any of the following activities? BEER/WINE SAMPLING YES NO COOKING CLASSES YES NO Note: Only beer/wine specialty stores may have sampling or cooking classes. DELIVERY OF BEER/WINE INTERNET SALES YES YES NO NO If you have checked any of the above boxes, answer the appropriate questions below, sign, date, and return this document. 1. Where will the sale of your products (including alcohol) take place? (Inventory must be kept and sales must take place at the same location.) _________________________________________________________________________________ 2. How do you plan to deliver the product? 3. How will you be certain only people 21 or older make the purchase and receive the delivery? 4. If you plan to sell out of Washington, how will you determine the age of the buyer and receiver and how will it be delivered? OTHER ________________________________________________________________________________ __________________________________ Signature ______________________________ Date LIQ 847-50-2/05 American LegalNet, Inc. www.FormsWorkflow.com