Liquor License Manager Change Form

Liquor License Manager Change Form
Submit this form to request a change of the designated liquor license manager for your business.
Business Name
Liquor License Number
Business Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Current Manager Name
First NameLast Name
New Manager Name
First NameLast Name
New Manager Email
example@example.com
New Manager Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Effective Date of Change
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Reason for Manager Change
Should be Empty: