Licensing and Regulation
PO Box 43098 Trade Name
Olympia WA 98504-3098
Phone – (360) 664-1600 License Number
Fax – (360) 753-2710
www.liq.wa.gov UBI Number
ADDED ACTIVITIES FOR BEER/WINE GROCERY STORES
Do you want any of the following activities?
Beer or Wine Sampling Yes No
Cooking Classes Yes No
Note: To qualify for the above activities, you must also apply for the Beer/Wine Tasting Endorsement.
Delivery of Beer or Wine Yes No
Internet Sales Yes No
If you have answered YES to any of the activities above, please answer the appropriate questions listed
below. If you have answered NO to all of the activities, your signature and date is all that is required.
1 Where will the sale of your products (including alcohol) take place?
2 How do you plan to deliver the product?
3 How will you be certain only people 21 or older make the purchase and receive the delivery?
If you plan to sell out of Washington, how will you determine the age of the buyer and receiver and how
4 will it be delivered?
CENTRAL WAREHOUSING FOR WINE AND/OR SPIRITS Yes No
If YES, please submit a completed Warehouse Registration form and the required documents.
Signature (Sole Proprietor, Partner, Corporate Officer, LLC Member/Manager) Date
LIQ 129 12/11