Form 363 - Maryland Common Carrier Direct Wine Shipment Report - 2013 Page 2
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1
2
3MARYLAND COMMON CARRIER
2013
FORM
363
DIRECT WINE SHIPMENT REPORT
Common Carrier’s Name
Federal Employer ID Number (FEIN)
-
A
B
C
D
E
Name & Address
Date of
Name & Address
Date of
Total Liters
of Direct Wine Shipper
Shipment
of Consumer Shipped to
Delivery to
Shipped
Consumer
1
2
3
4
5
6
7
8
9
10
In lieu of using this form to report each sale, a hard-copy report with the same information may be submitted.
COM/RAD-363
Rev. 03/13
Page 2
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