Form Abc-412 - Beer Brand Registration printable pdf download

Form Abc-412 - Beer Brand Registration

Department of Alcoholic Beverage Control

State of California

EDMUND G. BROWN JR., Governor

BEER BRAND REGISTRATION

See additional instructions, ABC-412 Instructions.

Completed forms can be emailed to: beerbrandregistration@abc.ca.gov

Or sent to the address below:

Alcoholic Beverage Control

Attn: Price Posting

3927 Lennane Drive, Ste. 100

Sacramento, CA 95834

1. MANUFACTURER'S LEGAL NAME

2. CALIFORNIA ABC LICENSE NUMBER

Pending

3. MANUFACTURER'S ADDRESS (Street number and name, city, state, zip code)

4. CERTIFICATE OF COMPLIANCE NUMBER

Pending

5. EMAIL ADDRESS

6. IS PRODUCT CONTRACT BREWED?

Yes

If Yes, complete question #7. If No, skip to question #8.

7. CONTRACTOR'S TRUE NAME (NOT "DBA" or Fictitious Business Name)

8. IS MANUFACTURER USING A FICTITIOUS BUSINESS NAME (FBN) ON LABEL?

(If not previously provided, include a copy of the filed FBN)

Yes

If Yes, complete question #9. If No, skip to question #10

9. FICTITIOUS BUSINESS NAME (FBN)

10. HAS FICTITIOUS BUSINESS NAME STATEMENT BEEN FILED WITH THE APPROPRIATE COUNTY?

Yes

11. BRAND NAME. (IF ANY OF THE BRANDS LISTED BELOW INVOLVE MORE THAN ONE BREWER IN A COLLABORATIVE

CLASS OR TYPE

ALCOHOL

OR JOINT VENTURE, LIST THE NAMES AND ADDRESSES OF EACH BEER MANUFACTURER NEXT TO THE BRAND NAME.)

(i.e. lager; ale; stout;

PERCENTAGE

etc.)

(By volume)

12. AUTHORIZED SIGNATURE

13. DATE SIGNED

ABC-412 (12/15)

Form Abc-412 - Beer Brand Registration