Form Avp-2 - Montana Vendor Permit (Page 2 of 2) in pdf

Form Avp-2 - Montana Vendor Permit Page 2

Section 4 – Representative Information

Having made application above or being the current holder of MT Vendor Permit No. ______________________________

we understand that we are required to employ at least one, but not more than three, representatives to promote the

sale of liquor products in the state of Montana. We request approval to register the following Montana residents as

representatives:

Name ______________________________________________ Telephone Number _______________________

Address ___________________________________________________________________________________

Name ______________________________________________ Telephone Number _______________________

Address ___________________________________________________________________________________

Name ______________________________________________ Telephone Number _______________________

Address ___________________________________________________________________________________

Please have each representative listed above complete a Statement of Representative Form SUPAVP-2, which can be found

on our website at

Section 5 - Declaration and Affidavit

I declare under penalty of false swearing that I am the applicant or the duly authorized representative of the entity making

this application, and that the responses provided, including any accompanying information, are true, correct and complete.

____________________________

________________ ________________________ _________________________

Signature

Date

Printed Name

Title

Mail completed application and all necessary documents to:

Montana Department of Revenue

Liquor Control Division

PO Box 1712

Helena, MT 59624-1712

Questions?

Call us toll free at 1-866-859-2254 (in Helena, 444-6900) or Fax: (406) 444-0722

Montana Vendor Permit

Form Avp-2 - Montana Vendor Permit Page 2