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CONVENIENCE STORE SUPPLEMENTAL …
Page 1 of 1 CONVENIENCE STORE SUPPLEMENTAL APPLICATION (Include ACORD application) Applicant s Name: Location Address: Mailing Address: How long in business? Under same management? Yes No Receipts: Liquor Sales $ Number of Employees:Full-Time Part-Time Gas Sales $ Operating Hours: Other $ Days: Total $ ATM on premises? Yes No Lottery machines? Yes No If yes, total sales: $ LPG tank filling? Yes No By Employee or Customer? LPG sales: $ LPG tank swap?
Page 1 of 1 CONVENIENCE STORE SUPPLEMENTAL APPLICATION (Include ACORD application) Applicant’s Name: Location Address: Mailing Address:
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