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Label Approval Application ABC-412 - California

Label Approval Application Form. This is a California form and can be used in Department Of Alcoholic Beverage Control Statewide .
 Fillable pdf Last Modified 5/2/2011
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Department of Alcoholic Beverage Control MALT BEVERAGE LABEL FILING APPLICATION Submit this form to the Department of ABC, Attn: Price Posting, 3927 Lennane Drive, Suite 100, Sacramento, CA 95834. Include labels attached to a separate sheet of paper (no photocopies or size reductions ). Also include an endorsed copy of your fictitious business name statement, if applicable. (See additional instructions, ABC-412 Instr.) 1. MANUFACTURER'S LEGAL NAME 2. CALIFORNIA ABC LICENSE NUMBER State of California EDMUND G. BROWN JR., Governor Pending 3. MANUFACTURER'S ADDRESS (Street number and name, city, state, zip code) 4. CERTIFICATE OF COMPLIANCE NUMBER Pending 5. CONTACT PERSON'S NAME 6. CONTACT PHONE NUMBER 7. IS THE MANUFACTURER OF THE PRODUCT DIFFERENT FROM THE SHIPPER Yes No If Yes, complete questions #8-11. If No, skip to question #12. 8. SHIPPER'S NAME (As appears on Bill of Lading as Consignor) 9. SHIPPER'S ADDRESS (Street number and name, city, state, zip code) 10. CONTACT PERSON'S NAME 11. CONTACT PHONE NUMBER 12. IS PRODUCT CONTRACT BREWED? Yes 13. CONTRACTOR'S NAME No If Yes, complete questions #13-17. If No, skip to question #18. 14. IF IN CA, LICENSE NUMBER Pending 15. CONTRACTOR'S ADDRESS (Street number and name, city, state, zip code) 16. CONTACT PERSON'S NAME 17. CONTACT PHONE NUMBER 18. IS MANUFACTURER USING A FICTITIOUS BUSINESS NAME ON LABEL? Yes 19. FICTITIOUS BUSINESS NAME No If Yes, complete questions #19-20. If No, skip to question #21. 20. HAS FICTITIOUS BUSINESS NAME STATEMENT BEEN FILED PREVIOUSLY WITH ABC? Yes Yes 22. PRODUCT BRAND(S) No No SIZE(S) ALCOHOL CONTENT PERCENTAGE (By volume) 21. IS THIS PRODUCT REQUIRED TO BE LABELED PURSUANT TO SECTION 25205 OF THE ABC ACT? 23. AUTHORIZED SIGNATURE 24. DATE SIGNED FOR ABC USE ONLY DATE MAILED Label(s) Accepted For Filing Label(s) Rejected For Filing (See attached ABC-412 INSTR) DEPARTMENT SIGNATURE ABC-412 (04/11) American LegalNet, Inc. www.FormsWorkFlow.com
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