SOUTH CAROLINA DEPARTMENT OF REVENUE
Alcoholic Beverage Licensing
301 Gervais St, PO Box 125, Columbia, SC 29214
Telephone (803) 734-0470
BEER AND WINE PRODUCERS AUTHORIZATION OF WHOLESALERS
Registered Producer and address__________________________________________________________________
_____________________________________________________________________________________________
List Registration Permit No.____________________ or check if application for permit is pending (
)
Contact Person_______________________________________ Telephone No. (
)______________________
INSTRUCTIONS:
List below the names of wholesalers along with their territories in South Carolina authorized
by you to sell your brands and the brands each is authorized to sell.
Name of Wholesaler
Territory
Brand Names
Country of Orgin
(if imported)
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ABL 500 (10/96)