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Get Application For Retailer's (Buyer's) - Minnesota Department Of Public ... - Dps Mn

Hone (651) 201-7507 TDD (651) 282-6555 Fax (651) 297-5259 CARD NUMBER (Office Use Only) APPLICATION FOR RETAILER S (BUYER S) CARD FOR LIQUOR AND WINE PLEASE RETURN THIS APPLICATION WITH FEE $20.00 ISSUING AUTHORITY TYPE CODE BUYER S CARD EXPIRES PRINT NAME OF LICENSEE (AS SHOWN ON LICENSE BUSINESS NAME (DBA) BUSINESS ADDRESS COUNTY CITY, STATE, ZIP CODE AUTHORIZED SIGNATURE IDENTIFICATION # PS 9135 (12/09) BUSINESS PHONE.

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