Order And Permit Form For Transportation Of Alcoholic Beverages printable pdf download

CULINARY USE PERMITEE

ORDER AND PERMIT FOR TRANSPORTATION OF ALCOHOLIC BEVERAGES

(Not Valid Unless Authenticated by the Virginia Alcohol Beverage Control Board)

The Undersigned,

holder of Permit Number ___________

Permittee

herby orders from you and requests you to order for said Permittee, at the prices, and upon the terms, as set forth

hereunder, for delivery F.O.B. at:

_____________________________________________________________

(Address of Permittee)

On the account of the undersigned from:

__________________________________

____________________________________________________

(Name of Wholesale Dealer in Alcohol)

(Address of Wholesale Dealer)

the following alcohol, to-wit:

Number and Kind

Number of

Kind of Alcohol

Totals

Kind of Packages

Packages

Individual Containers

Grand Total of Order F.O.B. Designated Address of Permittee

Upon Terms of Payment as Follows, To-Wit:

It is understood and agreed between the Virginia Alcoholic Beverage Control Board (hereinafter called the Board),

the undersigned Permittee (hereinafter called the Vendee), the manufacturer, wholesaler or distributor, from

whom it is requested that this purchase be made (hereinafter called the Vendor), as follows:

1. The alcohol herein described is ordered by the Board from the Vendor at the Vendee’s request.

2. The vendee hereby promises and agrees to pay the Board, or its assigns, upon the terms above stated, the net purchase price for

said alcohol beverages.

3. The vendee accompanies this request for this order with a certified check, post office money order, or cashier’s check for the sum of

$____________ payable to the Virginia Alcoholic Beverage Control Board, which shall be retained by the Board as payment of its mark-up on

this order.

4. The Board hereby assigns to the vendor the above written promise and agreement of the vendee to pay to the Board the said net purchase

price for alcoholic beverages as herinabove set forth, and the vendor hereby accepts the said assignment in full satisfaction and discharge of

all obligations of any and every kind of or on the part of the Board to the vendor under this order and contract and any and every transaction

related thereto; and the vendor hereby expressly releases the Board of all legal liability and of all obligation, legal or moral, to pay to the vendor

any sum or sums whatsoever on account of the purchase price of all alcoholic beverages embraced in this order.

5. The vendee, having selected the vendor and agreed upon the price and quality of the alcoholic beverages embraced in this order, hereby

releases the Board from all responsibility and liability for quality, delivery, or any other matter which may arise under this contract.

Given under (my) our hand(s) this ___________ day of _____________________________________

(Month)

(Year)

By: ___________________________________ Title: _____________________________________

Revised 11-18-2015

Order And Permit Form For Transportation Of Alcoholic Beverages

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