Form Wv/wne-02 - Direct Shipper'S Report Of Wine Shipped Into West Virginia Page 2

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WV/WNE-02
DIRECT SHIPPER'S REPORT OF WINE SHIPPED INTO WEST VIRGINIA
rtL166 v 6 Web
Schedule A
(Liters = Gallons x 3.7854)
Invoice Date
Invoice
WV/ABCA Permitted
Customer Name
City
Total Invoice Wine Liters
MMDDYYYY
Number
Carrier Making Delivery
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Total Liters (Sum all total invoices) Enter here and on Page 1 Line 1
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