Dbpr Form Ab&t 4000a-002 - Retail Surcharge Invoice Worksheet Template - Department Of Business And Professional Regulation - Florida

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DBPR Form AB&T
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
4000A-002
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
Rev. 12/03
1940 NORTH MONROE STREET • TALLAHASSEE, FL 32399-1022
RETAIL SURCHARGE INVOICE WORKSHEET
Licensee
License No.
Month
Kegs
Number of Cases
Cooler
Wine
Liquor
Date
Invoice No.
Supplier's Name
Gallons
Gallons
Gallons
1/2
12oz
16oz/32oz
TOTAL
GALLONS PER CASE / KEG
x 15.5
x 2.25
x 3.00
TOTAL GALLONS
G&P 03AUD07/08/95

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