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ATT-104 (Rev. 1/13)
APPLICATION FOR BRAND AND LABEL REGISTRATION
APPLICATION FOR BRAND AND LABEL REGISTRATION
AND DESIGNATION OF SALES TERRITORY
AND DESIGNATION OF SALES TERRITORY
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SUBMITTED BY :
Submit online at
https://gtc.dor.ga.gov
SUBMITTED TO :
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Georgia Department of Revenue
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Alcohol & Tobacco Division
E-mail:
ATDIV@dor.ga.gov
Telephone: (404) 417-4900
INSTRUCTIONS
1.
Application must be typed or printed.
2.
Application must be accompanied by one (1) label and a copy of the Federal Label Approval for each label being
registered.
3.
Application must be accompanied by a Letter of Authority to register brands if applicant is not the producer.
4.
Application must be signed by an officer or owner of the Company registered with the Department of Revenue.
Signatures should be legible, or have the name printed below the signature. Stamped signatures are not acceptable. All
other signatures require a GA Power of Attorney (Form RD-1061) to be included with each application.
5.
The registration fee for Distilled Spirits covers up to ten (10) brands when applying for Distilled Spirits license. To
register additional Distilled Spirits brands the processing fee is $10 per item. There is no fee required to register Wine
and Malt Beverage brands.
THE PROCESSING OF THIS APPLICATION WILL BE DELAYED UNLESS IT IS PROPERLY SIGNED, COMPLETE
INFORMATION FURNISHED, AND APPLICABLE QUESTIONS ANSWERED.
REASONS FOR SUBMITTING THIS APPLICATION (
CHECK ONE)
(FAILURE TO CHOOSE THE CORRECT OPTION COULD DELAY YOUR APPLICATION)
To register brand(s) with original license application.
(Include with license application and contingent upon issuance of license.)
To register brand(s) for special order shipping.
To register additional brand(s) and designate sales territory.
To designate additional territories for brand(s) previously registered.
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To re-designate sales territory for brand(s) previously registered to existing wholesaler.
A 30 day processing time required by
To designate a new wholesaler: requires a letter of release from present wholesaler.
Revenue Regulations
This is to certify that a copy of this form has been furnished to the wholesaler or wholesalers as required by Revenue Regulations.
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DATE
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