Seller Training Roster
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0W081502
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69-204
Comptroller of Public Accounts
PRINT FORM
CLEAR FIELDS
(Rev.8-15/2)
*692041
0W081502
*
Seller Training Roster
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Vendor name
Instructor name
Session date
Session time
Pres
entation time (C
igarettes, e-cigarette
s and tobacco products)
Session location (Street address)
City
County
State
The individuals whose names appear below have attended and completed a Seller Training Program approved by the Comptroller of Public Accounts:
DRIVER'S LICENSE NUMBER
STATE
NAME
DATE OF BIRTH
(Last, first, middle initial)
(Month, day, year)
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