Beer Manufacturer Information
Fill in all information on this form. Once your request is processed, you will recieve an email notification with instructions on how to place a request for alcoholic liquor to use for manufacturing canned cocktails. If you have any questions, please contact Accounting at
Your name *
Your Doing Business As (DBA) as listed on your class "A" beer permit or special class "A" beer permit *
Your license/permit number *
Please include the full license/permit number. Example: BAN000000, LC0000000, BB0000000
Your premises address *
Email address *
Notifications and instructions will go to this email address
Phone number *
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