Sole Source Of Supply Brand Registration Form {DR 8440}

DR 8440 (06/97) COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION 1375 SHERMAN ST. DENVER CO 80261 (303) 205-2300 COLORADO LICENSED IMPORTERS Sole Source of Supply/Brand Registration Form (See Instructions on back Page) For Sole Source Applications: 1. Attach a letter from each person whose product line you are applying for sole source authorization to import, stating that he is the United States' primary source of supply for his products and that he is appointing you as the Colorado sole source of supply for his products rather than obtaining his own Colorado importers license. For New Product Registrations: 1. Attach a copy of all Federal Brand Label Approvals for all new products you plan to ship into Colorado. Register all new products on space provided on this form. Attach a separate sheet, if necessary, to list additional products. 2. DO NOT WRITE IN THIS SPACE 2. 3. Pay appropriate fee. 3. 4. Sole source applicants fill in the information in the space provided below on this form. Register all new products for which you will become the sole source, on this form. Pay appropriate fee. ALL IMPORTERS FILL OUT THIS SECTION Applicant Name: Trade Name: Mailing Address (Street Number, City, State, Zip): Colorado Wholesaler(s) Product(s) will be shipped to: (Press firmly or type) Colorado License Number: Federal Basic Permit Number: Telephone Number: Sole Source Applications Name of Primary Source: Telephone Number: Federal Permit Number: Address of Primary Source (Street Number, Box Number, Rte., City, State, Zip): New Product Registration Product Name: 1. 2. 3. 4. 5.. 6. Sole Source Registration 2240 100 (999)......... Product Registration 2290 100 (999)................. $100 x ___________________ $5.00 x___________________ Total Fee:________________________ Total Fee:________________________ DR 8440 (06/97) COLORADO LICENSED IMPORTERS Sole Source of Supply/Brand Registration Form Name of Importer: Colorado License Number: Period: Sole Source Registration .... 2 2 4 0 Product Registration ............. 2 2 9 0 100 (999) 100 (999) $100 x _________ $5.00 x_________ Total Fee:______________ Total Fee:______________ American LegalNet, Inc. www.FormsWorkflow.com Instructions: This form applies to all new products and sole source authorizations not previously registered prior to July 1, 1989, and is required to be filled out to register all new products that a Colorado licensed importer has not previously registered with the State of Colorado. This applies to all situations where a federal brand label approval has been issued to an alcoholic beverage product. However, the registering of one size of the same product shall be deemed adequate for the registering of all sizes of the same identically labeled product. This form is also required to be filled out by all Colorado licensed importers who are not the United States' primary source of supply for a brand of product or product line, and who desire to be registered as the Colorado sole source for that brand or product line. American LegalNet, Inc. www.FormsWorkflow.com