Massachusetts > Statewide > Alcoholic Beverages Commission
Application For A Consumer Research Special Permit - Massachusetts
| Application For A Consumer Research Special Permit Form. This is a Massachusetts form and can be used in Alcoholic Beverages Commission Statewide . |
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Commonwealth of Massachusetts Alcoholic Beverages Control Commission 239 Causeway Street Boston, MA 02114 www.mass.gov/abcc The Application for a Consumer Research Special Permit MONETARY TRANSMITTAL FORM [APPLICATION MUST BE COMPLETED ONLINE] ECRT CODE: CONS CHECK PAYABLE TO ABCC OR COMMONWEALTH OF MA: (CHECK MUST DENOTE THE NAME OF THE LICENSEE CORPORATION, LLC, PARTNERSHIP, OR INDIVIDUAL) CHECK NUMBER IF USED EPAY, CONFIRMATION NUMBER: A.B.C.C. LICENSE NUMBER (IF AN EXISTING LICENSEE): LICENSEE NAME: ADDRESS: CITY/TOWN: STATE ZIP CODE LICENSE TYPE CONSUMER RESEARCH SPECIAL PERMIT LICENSE TYPE CONSUMER RESEARCH SPECIAL PERMIT FEE $250.00 per day # OF PERMITS COST FEE $250.00 per session # OF SESSIONS COST NOTE: THERE IS AN AUTOMATIC DAY FEE OF $250.00 + THE NUMBER OF SESSIONS YOU MUST MAIL THIS TRANSMITTAL FORM ALONG WITH YOUR CHECK AND COMPLETED APPLICATION TO: ALCOHOLIC BEVERAGES CONTROL COMMISSION P. O. BOX 3396 BOSTON, MA 02241-3396 American LegalNet, Inc. www.FormsWorkFlow.com Application for a Consumer Research Special Permit 1. Applicant Information: Applicant Name: (Name of Massachusetts Company) Name of Individual Responsible on Site: Address: Telephone: Address Where the Permit Shall Be Mailed: Fax: City/Town: State Zip City/Town: State Zip 2. Research Information Name of Product Location Where Research is Being Performed: 3. Tasting Information: On-Premise Off-Premise Registration Date: Date(s) of Activity: Number of Sessions: Is Food Being Served? Yes No Time(s) of Activity If yes, please describe the type of food: Name of Massachusetts Wholesaler Delivering to Site: Describe How You Will Obtain Participants: Describe How You Will Verify Identification: Will You Provide Transportation? Yes If yes, please describe the transportation: No I, HEREBY SWEAR UNDER THE PAINS AND PENALTIES OF PERJURY THAT THE INFORMATION I HAVE GIVEN IN THIS APPLICATION IS TRUE. Signature Title Date American LegalNet, Inc. www.FormsWorkFlow.com
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