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2. Liquor Licensee:*
   (Corporation, partnership or individual listed on the state license)
3. Caterer Contact Name:*

   (Name of person requesting catering permit)

5. Contact Phone #:*
6. Contact Email:*
8. Licensee Address:*
   (City, State, Zip Code)
10. State of Idaho Current Liquor by the Drink License #*
    (CURRENT)
12. Name of Person Coordinating the Event:*
13. Event Coordinator Phone #:*
15. Date of Permit Use:*
    (Month, Day, Year)
16. Hours:*
    (Begin to End)
18. Located At:*
    (Location Address, Room or Suite(s)
19. Catering For:*

    (Name of Event, Party, or Convention)

21. Type of Alcohol to be Served:*

    (i.e. Beer, Wine, Liquor)

22. Type of Serving Containers:*

    (i.e. Cups, Cans, Bottles, Growlers)

24. Sponsored By:*

    (Name of Organization, Group, or Person)

25. Number of Attendees Expected:*
27. Number of days sponsored event will be open to the named organization(s), group(s) or person(s) and guests:*
    Not to exceed three (3) consecutive days at a fee of twenty dollars ($20.00) per day.
29. By checking the "I agree" box below, you agree and acknowledge that 1) Your application will not be signed in the sense of a traditional paper document, 2) By signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) You may still be required to provide a traditional signature at a later date.
31. Electronic Signature Agreement

    1. I Agree
35. Unless license is disqualified, approval of this permit does certify the license is entitled to hold and use this Idaho Liquor Catering Permit at the above designated premises, subject to provisions of Idaho State Code Tittle 23-1.C.
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field