NH Liquor

Credit Application

Please fill out this form and mail to:
New Hampshire State Liquor Commission
Attention: Accounts Receivables
P.O. Box 503
Concord, NH 03301-0503
Phone# (603) 230-7053 Fax# (603) 271-2375

for the following establishment:

       
 
Type of Business:
     
     
  
   

I certify that the above information is correct and that neither the business applying for credit or any principals or owners thereof is currently involved or has ever filed for bankruptcy as an individual or as a principal of a business. I understand that credit is assigned by license number. Should I obtain a new license number for any reason, I must reapply for credit.

* If there has been a previous bankruptcy, please forward all details with this application.

Authorized Signature Form