Form Abc-866 - Request For Approval Of Mixed Alcoholic Liquor Served In Pitchers

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Kansas Department of Revenue
Alcoholic Beverage Control Division
915 S.W. Harrison Street
Topeka, KS 66625-3512
Phone: 785-296-7015 Fax: 785-296-7185
REQUEST FOR APPROVAL
OF MIXED ALCOHOLIC LIQUOR SERVED IN PITCHERS
Who may complete this form?
Any on-premise licensee seeking approval from the Director for the sale and service in a pitcher of
mixed alcoholic beverages that are not currently approved may complete and submit this form to the
address or fax number above to request approval from the Director of ABC.
List only one type of mixed alcoholic beverages per request.
If the request is approved, it will be posted to our website at
LICENSEE INFORMATION:
Licensee Name
License No.
Licensee Mailing Address
City
Zip
Contact Person Name
Email Address
Phone Number
Fax Number
Requested By Name (please print)
PITCHER INFORMATION:
(Enter the name of the mixed beverage and description, if any, in the space below).
_______________________________________
_________________________________________
Authorized Signature
Date
ABC Office Use Only
Signature of ABC Director
Date
APPROVED
DENIED
Notified by
Email
mail
fax
Approved Pitchers Only:
Posted to ABC Website
Clear Form
ABC-866 (7.1.13)

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