Business Modification

STATE OF MARYLAND

MONTGOMERY COUNTY

Alcohol Beverage Services

APPLICATION FOR
BUSINESS MODIFICATION

LICENSEE DETAILS

LICENSEE EMAIL ADDRESS*

LICENSE NUMBER*

LICENSEE NAME*

LICENSEE PHONE*

FACILITY NAME*

FACILITY ADDRESS*

Address Line 1

Address Line 2

City

State

ZIP Code

BUSINESS MODIFICATION PLAN DETAILS

Please explain the change you are requesting from your current approved business plan.

DINING SEATS*

BAR SEATS*

TOTAL SEATS*

RESTROOMS*

FULL SERVICE KITCHEN*

FLOORS*

ROOMS*

WAIT SERVICE?*

OUTDOOR CAFE?*

OUTDOOR CAFE SEATS*

36" BARRIER?*

ROOM SERVICE?*

WINE TASTING?*

OTHER

DOCUMENTATION

Attach new floor plan.

FLOOR PLAN*

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LICENSEE SIGNATURE

This form requires the signatures of all licensees.
This form will not be processed until all signatures have been submitted.
Use link below to access the signature page for additional signatures.

Signature Page

By signing this report, I do solemnly declare and affirm under the penalties of perjury, that the contents of the foregoing report are true and correct to the best of my knowledge, information and belief.

LICENSEE SIGNATURE*

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