Fillable Application Consumer ResearchV2.0 (Commonwealth of Massachusetts)

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Application Consumer ResearchV2.0 (Commonwealth of Massachusetts)

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The Application Consumer ResearchV2.0 (Commonwealth of Massachusetts) form is 2 pages long and contains:

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  • 6 check-boxes
  • 38 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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Application for a Consumer Research Special Permit
MONETARY TRANSMITTAL FORM
[APPLICATION MUST BE COMPLETED ONLINE]
ECRT CODE: CONS
CHECK PAYABLE TO ABCC OR COMMONWEALTH OF MA:
IF USED EPAY, CONFIRMATION NUMBER:
A.B.C.C. LICENSE NUMBER (IF AN EXISTING LICENSEE):
LICENSEE NAME:
ADDRESS:
CITY/TOWN: STATE ZIP CODE
LICENSE TYPE FEE # OF PERMITS COST
CONSUMER RESEARCH $250.00 per day
The Commonwealth of Massachusetts
Alcoholic Beverages Control Commission
95 Fourth Street, Suite 3
Chelsea, MA 02150
www.mass.gov/abcc
SPECIAL PERMIT
LICENSE TYPE FEE # OF SESSIONS COST
CONSUMER RESEARCH $250.00 per session
SPECIAL PERMIT
NOTE: THERE IS AN AUTOMATIC DAY FEE OF $250.00 + THE NUMBER OF SESSIONS
CHECK NUMBER
(CHECK MUST DENOTE THE NAME OF THE LICENSEE CORPORATION, LLC, PARTNERSHIP, OR INDIVIDUAL)
YOU MUST MAIL THIS TRANSMITTAL FORM ALONG WITH
YOUR EPAY RECEIPT AND COMPLETED APPLICATION TO:
ALCOHOLIC BEVERAGES CONTROL COMMISSION
95 FOURTH STREET, SUITE 3
CHELSEA, MA 02150
Print Form
Application for a Consumer Research Special Permit
Applicant Name:
Address:
Telephone:
1. Applicant Information:
City/Town: State Zip
Email Address:
2. Research Information
Name of Product
3. Tasting Information:
Location Where Research is Being Performed:
On-Premise Off-Premise
Registration Date:
Signature Date
Title
(Name of Massachusetts Company)
Name of Individual Responsible on Site:
Address Where the Permit Shall Be Mailed: City/Town: State Zip
Date(s) of Activity: Time(s) of Activity
Number of Sessions:
Is Food Being Served?
Yes No
If yes, please describe the type of food:
Name of Massachusetts Wholesaler Delivering to Site:
Describe How You Will Obtain Participants:
Describe How You Will Verify Identification:
Will You Provide Transportation?
Yes No
If yes, please describe the transportation:
I, HEREBY SWEAR UNDER THE PAINS AND PENALTIES OF PERJURY THAT THE INFORMATION I HAVE GIVEN IN THIS APPLICATION IS TRUE.
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Application Consumer ResearchV2.0 (Commonwealth of Massachusetts)

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Completed 19 July 2020

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