Form Wv/wne-01 - West Virginia Wine Supplier'S Report Page 2
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3WV/WNE-01
WEST VIRGINIA WINE SUPPLIER'S REPORT
rtL165V 6 Web
SECTION 1 - WINE SHIPPED INTO WEST VIRGINIA
(Liters = Gallons x 3.7854)
Non-registered suppliers - Report on section 2, page 3
Wholesaler/Distributor Sold Or Delivered To
Invoice Information
Wine Shipped into WV
(Column A)
(Column B)
(Column C)
Business Name
Invoice #
Invoice Date (MMDDYYYY)
# Liters
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Total number of liters shipped into West Virginia (Enter here and on Page 1 Line 1)
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Page 2 of 3
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