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The Washington Liq 365 form serves as a crucial component in the process of obtaining an Agent’s License for individuals representing businesses involved in the retail sale of alcoholic beverages, including beer, wine, and spirits. This application is not merely a formality; it requires careful attention to detail and full compliance with the regulations set forth by Washington State liquor laws. Applicants must provide essential information, such as the full legal name of the company, its license number, and contact details. Furthermore, the form prompts agents to disclose any other employment or financial interests that may intersect with their role in the alcohol retail sector. This transparency is vital, as any misrepresentation can lead to serious consequences, including the disapproval or revocation of the license. The fee for processing this application is $25, and it is important to note that Agent’s Licenses expire annually on June 30th, necessitating timely renewals. By signing the form, both the applicant company and the agent affirm their commitment to adhere to the relevant laws and regulations, ensuring that the integrity of the liquor licensing process is maintained.

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Licensing and Regulation PO Box 43098 Olympia WA 98504-3098 Phone: (360) 664-1600 Fax: (360) 664-4054 www.liq.wa.gov

For Office Use Only

Date:

Check No.

Amount Rec’d

Rec’d By

Application for Agent’s License

$25 Fee

Agent’s Licenses Expire June 30th

To Be Completed by Applicant Company

 

Full Legal Name of Company or Corporation Represented by Agent

License No. of Company

 

 

 

 

 

 

Address (City, State, Zip Code)

E-mail address

Telephone No.

 

 

 

 

 

 

 

 

 

 

To Be Completed by Agent

 

 

 

 

 

 

 

Agent’s Name (First, Middle, Last) Please print

Date of Birth

 

 

 

 

 

 

 

 

 

Agent’s Business Address (if different from applicant company)

 

Telephone No.

 

 

 

 

(

)

 

 

 

 

 

 

 

Do you hold any other job or engage in any other employment with or without pay?

If yes, please explain:

yes

no

Do you have any financial interest of any nature whatsoever in any business involved in the retail sale of beer, wine, or spirituous liquor (including lessor or landlord interests in building; or being a holder of a note,

 

mortgage contract, or other forms of obligations or credit arrangements)?

yes

no

 

If yes, please explain.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To Be Completed by Applicant Company and Agent

In making this application we agree, if application is approved, to abide by the provisions of the Washington State liquor laws and regulations, with particular reference to RCW 66.24.310, WAC 314-44-005, and WAC 314-12-140. We understand a misrepresentation of fact shall be deemed a lack of good faith and shall constitute good and sufficient cause for disapproval, revocation, or suspension of the license.

Agent’s Signature

 

Date

 

 

 

Company Authorized Signature

 

Date

 

 

 

If you have any questions or need assistance, please call (360) 664-1600 Select option 2

LIQ 365 8/11

Document Overview

Fact Name Description
Purpose The Washington LIQ 365 form is used to apply for an agent's license in the liquor industry.
Fee A fee of $25 is required for the processing of the agent's license application.
Expiration Agent's licenses issued under this form expire annually on June 30th.
Governing Laws This application is governed by Washington State liquor laws, specifically RCW 66.24.310, WAC 314-44-005, and WAC 314-12-140.
Contact Information For assistance, applicants can contact the Licensing and Regulation office at (360) 664-1600 or visit their website at www.liq.wa.gov.
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