¨ Farm alcohol beverage producer
¨ Wholesaler
¨  Manufacturer
¨  Importer

Licensee:

Premises Address:

Marketing Permit Number

Appointment of Authorized Agent for tastings and bottle sales

(Your name as it appears on your License) hereby appoints (Name of your representative) as its Authorized Agent for tastings and bottle sales.  This appointment shall be effective for one year from the date signed.

                        ________________________________           _____________________
Name and Title                                       Date