Form Dbpr Abt-6034 - Application For Bottle Club License And Retail Tobacco Products Dealer Permit
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14DBPR ABT-6034 – Division of Alcoholic Beverages and Tobacco Application for Bottle Club
License and Retail Tobacco Products Dealer Permit
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?
Transfer of Ownership
Yes
No
Change of Location
Change of Business Name
Change of Officers/Stockholders
Correction
SECTION 2 - CHECK LICENSE CATEGORY
Bottle Club License
Retail Tobacco Products Dealer Permit
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
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