Credential Submission Form for Municipal Users
Please complete the below form to submit credentials for registration in the Division of Alcoholic Beverage Control’s Online Licensing System.
Purpose
*
- New Account
- Update Account
- Cancel Account
- Password Reset
Please List Name(s) of Users that Need to be Deactivated if Necessary
Please Indicate item(s) You have Updated
Full Name
*
First Name
Last Name
Office Number
*
Format: (000) 000-0000.
Office Number Extension
Cell Number
Format: (000) 000-0000.
Official E-mail
*
Confirmation Email
Municipal Code 1
*
Municipality/Town 1
*
Municipal Code 2
Municipality/Town 2
Municipal Code 3
Municipality/Town 3
Municipal Code 4
Municipality/Town 4
Submit Form
Should be Empty: