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Beer and Wine Privilege Business License Application
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This form has been modified since it was saved. Please review all fields before submitting.
BEER & WINE BUSINESS LICENSE APPLICATION
Application Date
Application Date
Type of Application
*
New Application
Renewal Application
Is a copy of your ABC Permit attached?
YES
NO
Does your business have a valid City of Durham Privilege License?
YES
NO
Check all that apply
Beer On-Premise
Beer Off-Premise
Wine On-Premise
Wine Off-Premise
This application is for the sale of beer and/or wine at retail. The undersigned applicant for license to sell beer and/or wine states that the answers to the following questions are true of his/her own knowledge and are made for the purpose of inducing the City Council of the City of Durham to issue a license to the undersigned for the sale of such alcoholic beverages as indicated within the corporate limits of the City of Durham.
BUSINESS INFORMATION
Corporation Name or Business Owner's Name
Include DBA if applicable
Email Address
Federal Tax Identification Number
North Carolina Alcoholic Beverage Control Commission Retail Permit Number
Physical Address of Business
Include any suite or apartment #. DO NOT use a PO Box.
Mailing Address
Business Location Phone Number
Cell Phone Number
Fax Number
BUSINESS OWNER'S INFORMATION
Full Name of Owner(s)
North Carolina Driver's License Number
Home Address
Home Phone Number
Business Phone Number
Business Fax Number
Cell Phone Number
Email Address
Length of Residence
In North Carolina (Years)
Are you a citizen of the United States?
YES
NO
How long have you operated this business?
(Years)
Have you ever been convicted of a felony or crime involving moral turpitude?
YES
NO
Have you ever been convicted of violating the Federal or State prohibition laws?
YES
NO
If YES, were you convicted at any time within the past two years?
YES
NO
Did you complete serving a sentence for any such violation during the past two years?
YES
NO
Have you had any license to sell alcoholic beverages revoked during the past five years?
YES
NO
If you had your license revoked in the last five years, when and why was the license revoked?
Provide as much detail as possible
As the present owner of this business, do you intend to operate this business yourself?
YES
NO
As the present owner of this business, do you intend to operate this business under your immediate supervision and direction?
YES
NO
To your knowledge, have any of the persons named in this application been convicted of any felony or crime involving moral turpitude, or of violation of the State or Federal Prohibition Laws?
YES
NO
BUSINESS MANAGER or OPERATOR OF BUSINESS
Full Name
North Carolina Driver's License Number
PREVIOUS OWNER of BUSINESS INFORMATION
Full Name
Phone Number
Address
OWNER of PREMISES
Full Name
Phone Number
Address
REFERENCES
Names and contact information of individuals whom you are not associated with in business.
NAME/ADDRESS/PHONE NUMBER
NAME/ADDRESS/PHONE NUMBER
NAME/ADDRESS/PHONE NUMBER
As a further inducement to the City Council of the City of Durham, the owner agrees that he/she will promptly report any change or condition that may affect the validity of the information provided above.
ELECTRONIC SIGNATURE AGREEMENT
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
I agree with the Electronic Signature Agreement
*
YES
NO
Digital Signature
Person making application
PRINT NAME
Person making application
Relationship to Business
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Service request:
Click or call 919-560-1200