Application For Remote Tasting Room - Arizona Department Of Liquor Licenses And Control
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4FOR DLLC USE ONLY
License#:
Arizona Department of Liquor Licenses and Control
800 W Washington 5th Floor
Date Processed:
Phoenix AZ 85007-2934
CSR:
(602) 542-5141
APPLICATION FOR REMOTE TASTING ROOM
Farm Winery: A.R.S. § 4-205.04(F) • Craft Distillery: A.R.S. § 4-205.10(D)
FINGERPRINT FEE: prices vary, card must be FBI-approved
APPLICATION FEE $100 • ISSUANCE FEE: full year = $200/half year = $150
A service fee of $25 will be charged for all dishonored checks (A.R.S. § 44-6852)
SECTION 1
Ownership:
1. Individual Owner/Agent’s Name:
(Must concurrently own a series 13, 18, 2W or 2D)
Last
First
Middle
2. Owner Name:
(Exactly as it appears on Liquor License)
3. Business Name:
(Exactly as it appears on the exterior of premises)
4. Business Location Address:
(Do not use PO Box)
Street
City
State
Zip
County
5. Mailing Address:
(All correspondence will be mailed to this address) Street
City
State
Zip
6a Business Phone: ______________________________________
6b Daytime Contact Number: _______________________________
7a Arizona Liquor License #:
7b Email Address: ___________________________________________
(Must be a series 13, 18, 2W or 2D license)
SECTION 2
All questions must be answered:
Yes
No 1. I verify that the attached diagram of the remote tasting room includes all exits, entrances, square footage,
liquor storage and service areas.
[farm winery: A.R.S. §4-205.04(F), craft distillery A.R.S. §4-205.10(D)]
Yes
No
2. I verify that the location of the remote tasting room is within the incorporated limits of the city/town named
in Section 1, question # 4.
Yes
No
3. I verify that the location of this remote tasting room is not within 300 feet of a church or
school building.
[A.R.S. §4-207]
Yes
No 4. I understand that the owner or agent for this remote tasting room must be a bona fide
resident of Arizona and that the following documents must be completed and attached to this
application:
Yes
No - owner/agent’s valid Title 4 (Arizona liquor law) training Certificate of Completion,
Yes
No - owner/agent’s completed questionnaire
Yes
No - owner/agent’s fingerprint card and fee
[A.R.S. §4-202(A)]
11/19/15
Page 1 of 4
Individuals requiring ADA accommodations please call (602)542-9027
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