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Beverage Manufacturer & Distributor Registration

Fields marked with an asterisk (*) are required. For questions regarding this form, please contact the Registration Unit at: (916) 323-1835.

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Company Information

Doing Business As *

Legal Name *

Website

Federal Tax ID *

ABC Certificate of Compliance or Direct Shippers Permit # (Out‐of‐state Beer Manufacturers & Wineries only)

Ownership Structure *

Beverage Information

1. This company is a (check all that apply):
Brewery
Distilled Spirits Manufacturer
Winery
None of These

2. Date company began sales or transfers of beverages in single use containers in California: *

3. Are free beverage product samples offered or proposed to be offered in California? *

Yes No

4. Are you selling direct through your website or other E-commerce platforms? *

Yes No

5. Provide the types of beverage products, their container types, and container sizes offered for sale or transfer, or proposed to be offered for sale or transfer in California: (Check all that apply) *

Container Size: (at least 1) *
Under 24 ounces
24 ounces or more

Refillable:(Empty beverage containers which are returned to your place of business to be refilled and resold) *
All None Some

Mark all that apply:
Growlers
Kegs
Other

Provide container size and material:

6. Do you bottle or can your own beverages? (Canning includes taproom sealed Crowlers) *

7. Who do you sell or transfer beverages directly to in California? (Check all customers that apply) *

Retailer Consumers Distributors Common Carriers Other

If other, please describe:

Provide any additional information:

Mailing Address

Address *

City *

State *

Zip *

Country *

Business Address

Same As Mailing Address

Address *

City *

State *

Zip *

Country *

California Warehouse Location(s) (if applicable)

Warehouse Ownership Type
Rented Leased Owned None

Address *

City *

State *

Zip *

Country *

Other California Address (if applicable)

Describe (Examples: Company owned bottling facility or sales office )

Address *

City *

State *

Zip *

Country *

Primary Contact

Salutation *

Job Title *

First Name *

Last Name *

Phone*

Email *

Will this person be responsible for submitting reports and payment to CalRecycle?*
Yes No

Secondary Contact

Salutation*

Job Title*

First Name*

Last Name*

Phone*

Email*

Will this person be responsible for submitting reports and payment to CalRecycle?*
Yes No

Other Contact

Add Other Contact

Salutation

Job Title

First Name

Last Name

Phone

Will this person be responsible for submitting reports and payment to CalRecycle?*
Yes No

Other Contact

Add Other Contact

Salutation

Job Title

First Name

Last Name

Phone

Will this person be responsible for submitting reports and payment to CalRecycle?*
Yes No

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