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Get VA Importer Designation and Authorization Form 2002-2024

NOTICE TO BRAND OWNER By completing and submitting this form according to Virginia law the designated Importer will be authorized to enter into agreements for territory assignments with Virginia licensed wholesalers on your behalf. All territory assignments made by your designated Importer are submitted to the Virginia Department of ABC on an Attachment B form and are binding. ATTACHMENT A IMPORTER DESIGNATION AND AUTHORIZATION FORM I. Name of Brand Owner is the lawful owner of the brand s of beer and/or wine listed in paragraph II and as the brand owner hereby authorizes Name of Applicant/Licensee Street Address of Applicant/Licensee City/State/Zip Virginia Importer s Number to sell and deliver or ship the same brands of wine and/or beer into the Commonwealth of Virginia pursuant to and in compliance with the relevant statutes and regulations of the Commonwealth which govern beer or wine importer licenses. II. The brands which the applicant named in paragraph I is authorized to sell and deliver or ship into Virginia are as follows. Name of Brands The above named applicant/licensee is hereby designated as the authorized representative of Name of Brand Owner for the purpose of establishing written agreements of a definite duration and within the meaning of the Beer Franchise Act 4. 1-500 et seq. of the code of Virginia and/or the Wine Franchise act 4. 1400 et seq. of the Code of Virginia with each wholesaler licensee of the Virginia Alcoholic Beverage Control Board to whom the above named importer sells any brand of beer or wine listed in paragraph II. IV. Please check the appropriate statement below This is an original authorization from the undersigned brand owner for the brands identified This is an amendment to an original authorization adding or deleting brands which the above named applicant or importer is authorized by the undersigned brand owner to import into Virginia* Signed by Date Signature of Person Executing Form and Title Rev* 9/02. II. The brands which the applicant named in paragraph I is authorized to sell and deliver or ship into Virginia are as follows. Name of Brands The above named applicant/licensee is hereby designated as the authorized representative of Name of Brand Owner for the purpose of establishing written agreements of a definite duration and within the meaning of the Beer Franchise Act 4. Name of Brands The above named applicant/licensee is hereby designated as the authorized representative of Name of Brand Owner for the purpose of establishing written agreements of a definite duration and within the meaning of the Beer Franchise Act 4. 1-500 et seq. of the code of Virginia and/or the Wine Franchise act 4. 1400 et seq. of the Code of Virginia with each wholesaler licensee of the Virginia Alcoholic Beverage Control Board to whom the above named importer sells any brand of beer or wine listed in paragraph II. II. The brands which the applicant named in paragraph I is authorized to sell and deliver or ship into Virginia are as follows. Name of Brands The above named applicant/licensee is hereby designated as the authorized representative of Name of Brand Owner for the purpose of establishing written agreements of a definite duration and within the meaning of the Beer Franchise Act 4. 1-500 et seq. of the code of Virginia and/or the Wine Franchise act 4. 1400 et seq. of the Code of Virginia with each wholesaler licensee of the Virginia Alcoholic Beverage Control Board to whom the above named importer sells any brand of beer or wine listed in paragraph II. .

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