* 1. PLEASE ENTER THE PREFERRED E-MAIL ADDRESS FOR IMPORTANT ABCC UPDATES.

* 2. PLEASE ENTER YOUR LICENSE NUMBER (NO DASHES OR SPACES)

* 3. PLEASE ENTER YOUR CORPORATION NAME

4. PLEASE ENTER YOUR DBA (IF AVAILABLE)

* 5. PLEASE ENTER A CONTACT PERSON FOR THE LICENSE

* 6. PLEASE ENTER THE CITY/TOWN OF THE LICENSED PREMISES

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