Form Att-104 - Brand And Label Registration And Designation Of Sales Territory (Page 2 of 2) in pdf

Form Att-104 - Brand And Label Registration And Designation Of Sales Territory Page 2

COMPLETE IN DUPLICATE

ATT- 104

APPLICATION FOR BRAND AND LABEL REGISTRATION

AND DESIGNATION OF SALES TERRITORY

SUBMIT TO:

SUBMITTED BY:

Georgia Department of Revenue

Alcohol & Tobacco Division

P.O. Box 38368

Atlanta, GA 30334

(404)656-4262

INSTRUCTIONS

1. Application must be typed or printed in ink.

2. Application must be submitted in duplicate along with a self- addressed, stamped envelope.

3. Application must be accompanied by one (1) label or a copy of the Federal Label Approval for each label being registered.

4. Application must be accompanied by a Letter of Authority if applicant is not the producer.

5. Application must be signed in BLUE INK by an officer or owner of the Company, in spaces provided on front and back.

Stamped signatures are not acceptable.

6. The registration fee for a distilled spirits applicant covers up to ten (10) brands. For the registration of additional brands in

excess of ten, the fee is $10.00 for each additional brand.

THE PROCESSING OF THIS APPLICATION WILL BE DELAYED UNLESS IT IS PROPERLY SIGNED, COMPLETE

INFORMATION FURNISHED, AND APPLICABLE QUESTIONS ANSWERED.

REASON FOR SUBMITTING THIS APPLICATION

(CHECK ONE)

[ ] To register brands with original license application

[ ] To register additional brand(s) and designate sales territory for additional brand(s)

[ ] To designate additional sales territory for brand(s) previously registered

[ ] To redesignate sales territory for brand previously registered

This is to certify that a copy of this form has been furnished to the wholesaler or wholesalers as required by Rules 560-2-3-.24,

560-2-4-.02 or 560-2-5-.02, where applicable.

Title

Date

Form Att-104 - Brand And Label Registration And Designation Of Sales Territory Page 2