Specializing in Federal and State Regulatory Compliance

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Thank you for you interest in Keldon Consulting. Please take a minute to complete this Information Sheet so that we can contact you with a detailed quote for services.

KELDON CONSULTING

New clients must fill out prior to doing business.

SPECIALIZING IN FEDERAL AND STATE REGULATORY COMPLIANCE
TTB • STATE • U.S. CUSTOMS • FDA • RECORD KEEPING • REPORTS

CUSTOMER INFORMATION

Company Name:
Billing Address:
Mailing Address:
Business Type:
Contact Person:
Phone Number:
Fax Number:
Email Address:
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Do you presently have a distilled spirits plant permit by ownership?

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For any of these locations please list number and address location.
Do you hold a state permit?

- Please provide the number here
What is your federal EIN number?
Do you have a basic wholesalers permit? - Please provide the number here
Do you have a basic importers permit?

- Please provide the number here?
Do you want any state applications filed?

- Please list the states you want filed.
Customer Information:
In order to fill out state and federal applications, we will need the following information on company officers.
Officer 1
Full Name
Address
Title (pres, CEO, director)
Social Security Number
Date of Birth
State of Birth
Drivers license Number
Officer 2
Full Name
Address
Title (pres, CEO, director)
Social Security Number
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