Application For Product/label Registration
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1
2Ohio Department of Commerce
Division of Liquor Control, Beer and Wine Section
Division Use Only
6606 Tussing Road, P.O. Box 4005
Reynoldsburg, Ohio 43068-9005
Reg. Date:
New Label
(614) 644-2411 Fax (614) 644-2480
_____ of _____
Check No.
Application for
Amount $
Product/Label Registration
See Page 2 “Specific Instructions / Document Checklist” for additional documents that MUST accompany your application
Please Print Legibly or Type:
Company Name:
Dba:
Company Address:
City:
State:
Zip Code:
Check here if this is a new mailing address
Telephone Number:
Ohio Supplier/Permit #:
Email/Phone:
Contact Person:
Type of Application:
New Product/Label - $50.00 Filing Fee - Allow 30-45 business days for processing
Label Revision - No Fee
or
Previous Approval Date:
New Size Container - Previous Approval Date (required)
- No Fee
Answer questions 1-6 below:
5. Identify the Alcoholic Beverage Classification: (REQUIRED)
1. Brand Name (REQUIRED):
Mixed Beverage:
Beer:
Wine:
List the Alcoholic Content:
2. Varietal or Type:
% alcohol by volume:
6. Are you registering a brand recently acquired from another company?
3. Fanciful Name (if any):
YES
NO
4. Appellation (wine only):
If YES, provide the name of former company:
PLEASE AFFIX ONE COMPLETE SET OF LABELS BELOW – (if necessary use separate sheet)
I hereby declare the above information is true and correct.
Title:
Print Name:
Signature: ____________________________________________________
Date: ___________________________________________________
DLC 1511 Rev. (3/30/2015)
TTY Users Dial ORS
An Equal Opportunity Employer and Service Provider
1-800-750-0750
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