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813.388.9457 |
www.BakerLawPA.com
Questionnaire - Alcoholic Beverage License
Please answer all questions as completely as possible to avoid processing delays.
Contact Person
First Name
Last Name
Phone
Email Address
Business Anticipated Opening Date
Section 1 - License Information
Applicant Entity Name
Applicant Entity Organization Type
Choose an option
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Organization State
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D/B/A
Have you registered the DBA with the FL Div. of Corporations and published it pursuant to F.S. 865.09?
Yes
No
N/A - Not using DBA
Have you obtained the Federal Employer Identification Number (EIN) for the Applicant Entity?
Yes
No
Please provide the EIN
Have you obtained the FL Dept. of Revenue Sales Tax Certificate for the Applicant Entity?
Yes
No
Please provide the Sales Tax Certificate Number
License Location Address
Mailing Address (if different)
Business Email
Business Phone
Has the applicant entity been convicted of a felony in this state, any other state, or by the United States in the last 15 years?
Yes
No
IF YES, please list all details, including the date of conviction, the crime for which the entity was convicted, and the city, county, state and court where the conviction took place.
Will the business sell tobacco products?
Yes
No
IF YES:
Pipes
Over the Counter
Vending Machine
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