(b) A signed statement from the Wholesaler, Broker, Importer, Shipper or Manufacturer in substantially the following format: Date: ______________
Time: Begin: __________ End: _________
Location Name:_______________________
Address: _____________________________________
_____________ ______________________
(city) (state) (ZIP code)
The undersigned hereby affirms that:
1. The excise tax on all alcohol beverages at the trade show has been paid and documentation of payment will be available at the trade show.2. All (Retailers/Retail Consumption Dealers) (Wholesalers) within the applicant's sales territory have been invited to the event.3. The event is without charge or cost of any kind to the attendees.4. The host is paying "fair market value" for the use of any retail licensed premises.5. All participants will be or have been advised in writing that a participant may only order Alcohol Products during the trade show and shall not receive shipment of orders for product onsite. Signed: ________________________________
Date: _____________________
Name:___________________________
(print or type)
Title: ___________________________
Company Name: ______________________
Ga. License No. _________