I request that the Department of Alcoholic Beverage Control grant approval for a remote retail outlet at the location described below:
Indicates a required field.
Name of Farm Winery:
E-mail Address:
Mailing Address:
ABC License Number:
Phone Number of Farm Winery: ext. (e.g., 555-555-5555) Note: Phone number extension is not required.
Fax Number: (e.g., 555-555-5555)
Name of Event:
Date(s) of Event:
Hours of Event:
Specific Address or Location of Event:
Describe area in which wine will be sold and consumed:
City/County:
Contact Person's Name (Organizer of the Event):
Contact's Phone Number ext. (e.g., 555-555-5555) Note: Phone number extension is not required.
Additional Comments:
To allow sufficient time for investigation, this form must be completed and submitted to this office ten days prior to the event.
Indicates a required field.