2. Licensed Premises Information
4. Liquor License Applicant*
6. Business dba Name*
8. Licensed Address*
10. City*
11. State*
12. Zip Code*
14. Liquor/Beer Agent Name*
18. Corporate Information
20. Business Legal Name (as on WI State Sellers Permit)*
22. Business Mailing Address*
24. City*
25. State*
26. Zip Code*
28. Business Contact Name / Position*
30. Business Phone Number*
31. Business Email*
33. License Type*

    1. Class "B" Beer
    2. Class "B" Beer & "Class B" Liquor
    3. "Class C" Wine & Class "B" Beer
    4. "Class B" Liquor (Winery Only)
35. Date of Event(s)*
37. Have you had this event in previous years?*

    1. Yes
    2. No
39. If so, please provide the previous dates.
41. Proposed License Description:*
43. Description of the Event:*
44. Detailed Map for Event. *
46. Security Plan*

    Provide the security plan indicating how the area will be monitored and secured to delineate area boundaries.

48. Is this Event in taking place during a Special Event? *

    1. Yes
    2. No
    3. Unsure

50. The information on this form is true and correct to the best of my knowledge. I understand the temporary expansion of the license premises requires approval from Committee/Council and is subject to complaint. 

    
    

52. 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.

    1. I agree.
54. Electronic Signature*
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit Submit and Print

* indicates a required field