Form Dbpr Abt-6018 - Application For Primary American Source Of Supply And Brand/label Registration Page 5
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7DBPR ABT-6018 – Division of Alcoholic Beverages and Tobacco Primary American Source of
Supply and Brand/Label Registration Application
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL
REGULATION
1940 North Monroe Street
Tallahassee, FL 32399-0783
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, at (850) 488-8288. Please send your completed
application and required fee(s) to:
Department of Business and Professional Regulation
1940 North Monroe Street
Tallahassee, FL 32399-1021
SECTION 1 - CHECK TRANSACTION REQUESTED
Transaction Type for Vinous and Distilled Spirits:
Primary American Source (PAS) Initial License
Revised Label(s)
(Enter brand number(s) in Section 4)
Transaction Type for Malt Beverages:
Brand/Label Registration
Fiscal Year July 1, 20____, through June 30, 20____
“FL/Florida” Imprinting
Revised Label(s)
(Enter brand number(s) in Section 4)
Approval
Exemption (Attach Exemption Request)
No change since prior approval
Exempt (Attach copy of each approval letter)
SECTION 2 - BUSINESS INFORMATION
Registrant/PAS Name
FL Document Number
Business Location Address
Telephone Number
Fax Number
City
State
Zip Code
Business Mailing Address
City
State
Zip Code
Type of Business:
Manufacturer
Distributor
Importer
Other: _______________________________________
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