Fillable Form Com/rad 330 - Beer Franchise Form printable pdf download

Form Com/rad 330 - Beer Franchise Form

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Comptroller of Maryland

Page _______ of ________

Beer Franchise Form

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Motor-fuel, Alchohol and Tobacco Tax Unit

P.O. Box 2999

Annapolis, Maryland 21404-2999

Phone: 410-260-7327 Fax: 410-974-3201

This supplementary statement will be made part of your license or permit file or will become a part of that license or permit file when issued.

Any changes to the below must be in accordance with Maryland Beer Franchise Fair Dealing Act and must be promptly reported to the Comptroller in writing.

(A)

(B)

UNIMERC Brand Code

Brand Name

Six digit number

Enter full brand name. Do not abbreviate.

(C)

Maryland Wholesale License No. or

(D)

Maryland Non-Resident or Resident

Name of Supplier

Dealer Permit No.

Seven digit number

(E)

List all sizes of this brand:

(F)

(G)

(H)

License number of Maryland wholesale distributor.

Name of distributor.

Assigned franchise territories. (Codes provided on reverse.)

I hereby certify that we are the brand owner, U.S. Importer, or designated Maryland agent of said brand owner or U.S. Importer in accordance with

Maryland laws. I further certify that these filings are not inconsistent with the Maryland Beer Franchise Fair Dealing Act or any prior franchise filings

made with the Motor-fuel, Alcohol and Tobacco Tax Unit.

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Instructions on page 2 - read carefully - incomplete or incorrect forms will be returned.

COM/RAD 330