Dbpr Form Abt-6026 - Examination Application

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DBPR ABT-6026 – Division of Alcoholic Beverages and Tobacco Application for Exporter Registration
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL
REGULATION
1940 North Monroe Street
Tallahassee, FL 32399-0783
If you have any questions or need assistance in completing this application, please contact the Department of
Business and Professional Regulation or your local district office. Please submit your completed application to
your local district office. This application may be submitted by mail, through appointment, or it can be dropped off.
A District Office Address and Contact Information Sheet can be found on AB&T’s page of the DBPR web site at
the link provided below.
SECTION 1 - CHECK TRANSACTION REQUESTED
Transaction Type:
New Registration
SECTION 2 - CHECK TYPE OF APPLICANT
Individual
Corporation
Partnership
Florida Corporate Charter Number: ___________________________
Limited Partnership
SECTION 3 - LICENSE INFORMATION
Full Name of Applicant (if this is a corporation or other legal entity, enter the name as registered with the
Secretary of State)
Business Name (D/B/A)
Principal Office Address (Street)
City
County
State
Zip Code
Mailing Address
City
State
Zip Code
Has applicant complied with all federal regulations, including federal permitting regulations?
Yes
No
List below the name, title and address for all principals of the business
NAME
TITLE
ADDRESS
(Attach extra sheets as necessary)
1

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