Form Abl-107a - Application For Registration Of Brands/wholesalers Of Alcoholic Liquors - 2010

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STATE OF SOUTH CAROLINA
1350
1350
DEPARTMENT OF REVENUE
ABL-107A
APPLICATION FOR REGISTRATION OF
(Rev. 8/31/10)
4288
BRANDS/WHOLESALERS OF ALCOHOLIC LIQUORS
Mail to: SC Department of Revenue, ABL Section,
Columbia, SC 29214-0907.
In accordance with Title 61, Chapter 6 Article 7, Code of Laws for SC, 1976, as amended, the Registered Producer noted
below does hereby make application to register the following brands of alcoholic liquors for shipment into the State of
South Carolina.
Registered Producer/Importer Name:
Address:
List S.C. Alcohol License No.:
(
)
Contact person:
Telephone
INSTRUCTIONS: You must list all labels/brands you intend to ship and the wholesaler you ship to. If additional
space is needed, this form may be reproduced. Please attach copy of Federal Label approval for each
label/brand listed.
Brand Name (list full brand name)
Proof
Age
Wholesaler
FEES: There is no fee for the first five (5) initial labels/brands registered for this producer/importer. The fee for each
additional brand over five is $20.00 per brand.
Total fees submitted:
42881029

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