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Brewer Importer Certification Of A Wholesaler Territorial Coverage WLD-035 - Wyoming
| Brewer Importer Certification Of A Wholesaler Territorial Coverage Form. This is a Wyoming form and can be used in Wyoming Liquor Commission Statewide . |
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WLD-035 (7/2012) MATTHEW H. MEAD Governor EDMUND J. SCHMIDT Director GREG COOK Administrator Phone: (307) 777-7231 Fax: (307) 777-6255 6601 Campstool Road, Cheyenne, Wyoming 82002-0110 Website: http://revenue.state.wy.us BREWER/IMPORTER CERTIFICATION OF A WHOLESALER TERRITORIAL COVERAGE (NOTE: Please prepare a separate statement for each wholesaler representing your brewery in the state of Wyoming.) In accordance with Section 12-2-201(b) of the Wyoming Statutes, the undersigned brewery representative certifies that the malt beverage wholesaler listed below is authorized to distribute brands shown in the designated geographical area. Date: Name of Brewery or Importer: Address: Telephone Number: Wholesaler Assigned to Distribute Products: City: Contact Name: Doing Business As: Doing Business As: State: / / ___ Zip: ___ ___ ___ DATE ASSIGNED BRANDS MARKETED If additional space needed, attach similar format sheets. TERRITORIAL/DISTRIBUTION AREA (Please list distribution areas by county or portions of counties, if possible) This assignment supersedes previous territorial assignment. As a representative of the brewery/importer named, I verify that the foregoing information is true to the best of my knowledge and represents a true statement of the distribution areas for our products in the state of Wyoming. Printed Name Title: Signature: Phone: ( ) FAX: ( ) American LegalNet, Inc. www.FormsWorkFlow.com
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