Arizona > Statewide > Liquor Licenses And Control
Sampling Privileges Form - Arizona
| Sampling Privileges Form Form. This is a Arizona form and can be used in Liquor Licenses And Control Statewide . |
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State of Arizona Department of Liquor Licenses and Control 800 W. Washington 5th Floor Phoenix, Arizona 85007 (602) 542-5141 Liquor Store (series 9) Beer and Wine Store (series 10) Sampling Privileges Form Applicant's Name: ____________________________________________________ (check one) Owner Agent Mailing Address: __________________________, _________________________, _____, ______________, ________-____ Street Address or P.O. Box City State County Zip Code Business Phone Number: _(______)________________________ Email: _____________________________________ Business Name: _________________________________________ Current License #: ______________________________ Physical Location of Business: __________________________________________, _________________________, _____, ______________, ________-_____ Street Address City State County Zip Code I, ___________________________________, understand that, upon approval, sampling privileges for the liquor license identified above will require compliance with the following: Initial Here _____ 1. the premises shall contain at least five thousand square feet to be eligible for sampling privileges for Beer and Wine Store (series 10) applicants only (A.R.S. §4-206.01(J)). 2. Any open product shall be kept locked by the licensee when the sampling area is not staffed. 3. The licensee is otherwise subject to all other provisions of this title. The licensee is liable for any violation of this title committed in connection with the sampling. 4. The licensed retailer shall make sales of sampled products from the licensed retail premises. 5. The licensee shall not charge any customer for the sampling of any products. 6. The sampling shall be conducted under the supervision of an employee of a sponsoring distiller, vintner, brewer, wholesaler or retail licensee. 7. Accurate records of sampling products dispensed shall be retained by the licensee. 8. Sampling shall be limited to three ounces of beer or cooler-type products, one ounce of wine and one ounce of distilled spirits per person, per brand, per day. 9. The sampling shall be conducted only on the licensed premises. 10. Upon approval of this form, a license for a liquor store with sampling privileges (series 9S) or a beer and wine store with sampling privileges (series 10S) will be issued and mailed to the licensee's address of record. The license must be displayed in a conspicuous public area of the licensed premises that is readily accessible for inspection by any peace officer, distributor, wholesaler or member of the public. (A.R.S. §4-261.01) _____ _____ _____ _____ _____ _____ _____ _____ _____ DLLC May 2012 1 American LegalNet, Inc. www.FormsWorkFlow.com _____ _____ 11. Liquor store license sampling privileges are not transferable. 12. I have read, understand, and assume responsibility for compliance with A.R.S. §4-206.01. A.R.S. §4-206.01. Bar, beer and wine bar or liquor store licenses; number permitted; fee; sampling privileges 1. Any open product shall be kept locked by the licensee when the sampling area is not staffed. 2. The licensee is otherwise subject to all other provisions of this title. The licensee is liable for any violation of this title committed in connection with the sampling. 3. The licensed retailer shall make sales of sampled products from the licensed retail premises. 4. The licensee shall not charge any customer for the sampling of any products. 5. The sampling shall be conducted under the supervision of an employee of a sponsoring distiller, vintner, brewer, wholesaler or retail licensee. 6. Accurate records of sampling products dispensed shall be retained by the licensee. 7. Sampling shall be limited to three ounces of beer or cooler-type products, one ounce of wine and one ounce of distilled spirits per person, per brand, per day. 8. The sampling shall be conducted only on the licensed premises. I, ______________________________________________, attest that I am the OWNER/AGENT filing this form, that I have read, and assume responsibility for compliance with, A.R.S. §4-206.01 at the licensed establishment named on page 1, and verify all statements I have made on this document to be true, correct and complete. I understand that I am responsible for the $100 issuance fee and the annual $ 60 renewal fee for these sampling privileges. Sampling privilege renewal fees are due at the same time as the renewal for the "current license #" identified on page 1 of this application. ______________________________________________, ________________________ ___/___/___ Signature, Title Date Notarized Signature The forgoing instrument was acknowledged before me this _______ of ________________, __________. day month year Notary Public: ______________________________________________________________ Signature My commission expires: __________, ________________, ___________ day month year For DLLC Use Only S License #: _________________________ Issuance fee applicable? Date of issuance: ______/______/______ Yes No $100 issuance fee collected Initials: ______________________ 2 American LegalNet, Inc. www.FormsWorkFlow.com
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