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Endorsement To Receive Wine And Cider Shipments Application - Oregon

Endorsement To Receive Wine And Cider Shipments Application Form. This is a Oregon form and can be used in Liquor Control Commission Statewide .
 Fillable pdf Last Modified 10/20/2014
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OREGON LIQUOR CONTROL COMMISSION ENDORSEMENT TO RECEIVE WINE AND CIDER SHIPMENTS APPLICATION for OREGON RETAILERS Licensee Name: ______________________________________Email:___________________________ Trade Name: _________________________________________ Fax:_____________________________ Premises Address: ___________________________________ City/Zip:_________________________ Please indicate the type of license you hold: Full On-Premises Limited On-Premises Off-Premises Brewery-Public House I am applying for the privilege to receive shipments from manufacturers of wine or cider outside of Oregon who hold a Wine Self Distribution permit. I understand that I may only accept shipments at the licensed location specified above. I understand that I must keep records of all deliveries I receive from Wine Self Distributor permit holders. I understand that I must keep these records for 2 years. I understand that I must submit monthly reports of the deliveries that I receive from permit holders on forms supplied by the Commission. The monthly reporting form will be mailed to you with your approval letter. The licensee or an authorized corporate officer or a member of a limited partnership or a Limited Liability Company must sign this application. Licensee Signature: ___________________________________ Date: ____________ RETURN FORM TO: OLCC PO BOX 22297 MILWAUKIE, OR 97269-2297 FAX: (503) 872-5018 PHONE: (503) 872-5123 OLCC USE ONLY License Number:____________________ Copy sent to licensee Approved by: _______________________ Date: _________________ (Rev. 12/11) American LegalNet, Inc. www.FormsWorkFlow.com
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