Compliance Form
-------------------------------------------------------------------------------------------------------------

PLEASE COMPLETE BELOW TO SUBMIT REQUEST TO COMPLIANCE:

***Brand Registrations may take up to 6 weeks or more - please allow sufficient time.


NOTE: REGISTRATION IS NOT REQUIRED FOR FOLLOWING STATES:
BEER - AK, AZ, DC, ID, IN, ND, VT, WI, WY
WINE - AK, AZ, CA, DC, ID, IN, NE, ND, OR, VT, WI, WY
SPIRITS - AI, AZ, CA, DC, IN, NE, ND, WI

--------------------------------------------------------------------------------------------------------------
   
Required FieldTitle / Request 
Requestor 
Request Date Pick
State 
Required FieldCompany Name 
Contact Info/Address 
Required FieldEmail 
Phone 
Fax 
Customer License #'s 
File 
Territories 
Brand - Label - Size(s) 
Required FieldAdditional Info