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Form Dbpr Abt-6024 - Application For Cigarette/tobacco Wholesaler, Tobacco Exporter, Or Cigarette Distributing Agent

DBPR ABT-6024 – Division of Alcoholic Beverages and Tobacco Application for Cigarette/Tobacco

Wholesaler, Tobacco Exporter, or Cigarette Distributing Agent

STATE OF FLORIDA

DEPARTMENT OF BUSINESS AND PROFESSIONAL

REGULATION

1940 North Monroe Street

Tallahassee, FL 32399-0783

NOTE – This form must be submitted as part of an

application packet

If you have any questions or need assistance in completing this application, please contact the

Department of Business and Professional Regulation. Please submit your completed application and

required fee(s) to your local district office. This application may be submitted by mail, through

appointment, or it can be dropped off. A District Office Address and Contact Information Sheet can be

found on AB&T’s page of the DBPR web site at the link provided below.

SECTION 1 - CHECK TRANSACTION REQUESTED

Transaction Type:

New License

Do you wish to purchase a Temporary License?

Yes

1. Change of Location

2. Change of Business Name

3. Change of Officers/Stockholders

4. Correction

Series Requested

SECTION 2 - CHECK LICENSE CATEGORY

Cigarette Wholesale Dealer

Cigarette Distributing Agent

Cigarette Exporter

SECTION 3 – LICENSE INFORMATION

Full Name of Applicant

(If this is a corporation or other legal entity, enter the name as registered with the Secretary of State)

Trade Name (D/B/A)

FEIN Number or Social Security Number*

Business Telephone Number

Location Address (Street and Number)

City

County

State

Zip Code

Mailing Address (Street or P.O. Box)

City

State

Zip Code

Resident Agent/Contact Person

Phone Number

Street Address

City

State

Zip Code

Form Dbpr Abt-6024 - Application For Cigarette/tobacco Wholesaler, Tobacco Exporter, Or Cigarette Distributing Agent

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