Dbpr Form Ab&t 4000a-015 - Application To Return Alcoholic Beverages December 2003
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1DBPR Form AB&T
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
4000A-015
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
Rev. 12/03
1940 NORTH MONROE STREET • TALLAHASSEE FL 32399-1022
APPLICATION TO RETURN ALCOHOLIC BEVERAGES
(Not Required For Stock or Code Rotation Authorized by Law)
I request permission to return alcoholic beverage products to the wholesaler after the 5-day return limitation has expired.
Business Name
License No.
License Type
Phone No.
(
)
Business Address (street and city)
Mailing Address
Contact Phone No's
Check the appropriate box(es):
Product is spoiled
Merchandise recalled by manufacturer
Bankruptcy
Merchandise not ordered
Business has closed
Bottles broken during delivery
Defaced or damaged containers
Unlawful containers
End of season return, if products will be
Other
out of code when the business reopens
Specify
Name and Address of Wholesaler Picking Up Product
Authorized Person
Making Request
Printed Name / Title
Signature
Date
Recommended Approval:
Yes
No
Printed Name / AB&T Supervisor
Signature
Date
Approval by the Division of Alcoholic Beverages and Tobacco does not require the wholesaler to comply with the request
(after the 5-day limit has expired.)
List product(s) to be returned and date product(s) was (were) purchased, or attach actual invoice(s). Use other side for
additional spaces.
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