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Customer Informations Change Form
Effective Date of License
Month
Month
Day
Year
Customer #
New DBA Name
Old DBA Name
New Location Phone
Rave Account Rep
New Liquor License #
Expiration Date
Month
Month
Day
Year
Business ID#
If on premise ,number of taps
Licensee Name
New Contact Person (First Name, Last Name)
Cellphone Number
Delivery Time Start
Time
:
Hours
Minutes
AM
Delivery Time End
Time
:
Hours
Minutes
AM
Submit
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