Sample and Blank Form Downloads
- ABCC-MUD-APPETHYL - Ethyl Alcohol License (PDF download)
- ABC FORM 12 (PDF Download)
- ABC Form 139 (PDF Download)
West Virginia Alcohol Regulatory Authority
- Issuing Authority: West Virginia Alcohol Beverage Control Administration
- Issuing Authority URL: https://abca.wv.gov/Pages/default.aspx
- Mailing Address: 900 Pennsylvania Ave., 4th Floor, Charleston, WV 25302
- Phone: 304-356-5500
- Email: Shawn.E.Smith@wv.gov
Steps to Complete Your ABCC-MUD-APPETHYL - Ethyl Alcohol License Form
Step 1: Download the Ethyl Alcohol License Application (Form ABCC-MUD-APPETHYL) using the link provided above.
Step 2: Fill out your business information:
- Enter your business name.
- Enter the Federal Employer ID Number.
- Enter your "Doing Business As" name. If it is not different from your business name, copy field 1.
- Enter your business telephone number.
- Enter your business physical address.
- Enter your business mailing address. If it is not different from your physical address, copy field 5.
Step 3: Check the box labeled "Industrial."
Step 4: Check the box appropriate for your business type. Next, enter your business e-mail. Then, enter the name and telephone number of the person who will be signing any ethyl alcohol (ethanol) order forms.
Step 5: Explain the purpose for which you will use the ethanol. Then, list the name and address of the vendor you will purchase from (for example: The Northern Maine Distilling Company, 55 Baker Blvd., Brewer, ME 04412).
Step 6: Enter West Virginia as the state and then the county in which your business resides (i.e., United States of America). Read the instructions for signing and make sure the appropriate individuals/partners/members sign and list their titles.
Step 7: Have a notary public sign and apply their seal on the application.
Step 8: Remember to enclose the proper fee ($50) with this application. Acceptable forms of payment for permit fees are cashier’s check, certified check, or money order. Fees are made payable to West Virginia Alcohol Beverage Control Administration, 900 Pennsylvania Avenue, 4th Floor Charleston, WV 25302.
Step 9: Mail completed application with the fee to: West Virginia Alcohol Beverage Control Administration, 900 Pennsylvania Avenue, 4th Floor Charleston, WV 25302.
Step 10: Receive back your approved permit via mail. If it has been 30 days and you have not yet received a response, inquiries can be made to (304) 356-5500, Monday through Friday, from 8:00am to 5:00pm Eastern Time.
Step 11: Once the license is granted to you, you will submit an order using ABC FORM 12 to the West Virginia ABC Commissioner who will then forward an approved order to the vendor to fulfill.
Steps to Complete Your ABC Form 12 - West Virginia Industrial Ethyl Alcohol Order Form
Step 1: Download ABC FORM 12 using the link provided above.
Step 2: Start by listing the date you would like the order shipped by and the method of delivery. Then list your business name and address.
Step 3: List the vendor name and address.
Step 4: Enter the quantity and proof of the ethanol you wish to purchase. Then list your ethanol license number.
Step 5: List your business name again. Then, the person filling out the application will fill in their name and title and date the application.
Step 6: Mail the completed order form to West Virginia Alcohol Beverage Control Administration, 900 Pennsylvania Avenue, 4th Floor Charleston, WV 25302.
Step 7: Wait for the vendor to receive your approved order form. Once the order is received, you will get an e-mail and can proceed with making your purchase at the secure online storefront.
Step 8: Make sure to fill out Form 139 when your shipment is received.
After Receipt of Order: Steps to Complete Your ABC Form 139 - West Virginia Industrial Ethyl Alcohol Reporting Form
NOTE: ABC Form 139 must be prepared and transmitted by email to the West Virginia Alcohol Beverage Control Commissioner on or before the 10th day of the succeeding month by the holder of the license to purchase and use ethanol.
Where there is no alcohol received, used, or on hand, ABC Form 139 should be rendered in blank, with the notation “No transactions” written across the face of the form.
Step 1: Open ABC Form 139 using the link provided above.
Step 2: Enter in your Ethyl Alcohol License Number in the top right corner of the application.
Step 3: Enter in your Licensee name (name listed on the license), the address, and the month you are reporting.
Step 4: Fill out the table detailing the alcohol you received during the month.
Step 4a: In Column 1, enter the date the shipment of alcohol reaches the licensee.
Step 4b: In Column 2, enter the vendor name.
Step 4c: In Column 3, enter the vendor address.
Step 4d: In Column 4, enter the serial numbers on the packages received.
Step 4e: In Column 5 & 6, enter the number of wine gallons in the shipment and proof of the alcohol. Then, enter the total number of gallons received for that month.
Step 5: Fill in the month's summary.
Step 5a: Line 1 should be reported the amount shown on hand the last day of the month on the report made for the previous month.
Step 5b: Line 2 enter the total of alcohol received during the month as shown by Column 5.
Step 5c: Line 4 report the quantity used during the month.
Step 5d: Line 5 should be reported any shortage from packages when received or any loss of alcohol after receipt. Any discrepancy between the amount of alcohol actually on hand at the end of the month and the amount which should be on hand must be reported at this line. All entries at this line must be fully explained by separate affidavits attached to and accompanying the report.
Step 5e: At line 6, report the amount of alcohol actually on hand on the last day of the month.
Step 6: Do not fill out any information in this last section until you are before a Notary Public. You will sign the document in the presence of the Notary and they will fill out the last bit of information required.
Step 7: E-mail the document to email@example.com. Make sure this form is submitted on or before the 10th day of the succeeding month by the holder of the license. Failure to submit the form on time each month could result in a revoked license.
Steps to Complete Your Purchase After Permit Approval
- Send us a copy of your approved permit to firstname.lastname@example.org.
- Return to https://CulinarySolvent.com and place your order for 200 proof food grade alcohol. Browse the selection of 200 proof food grade alcohol products for sale in sizes ranging from pints, quarts, gallons, five-gallon jugs, and fifty-five-gallon drums.
- Add desired products to your cart and complete your checkout online.
- Check your email for order confirmation, shipping confirmation, and tracking number to follow your order's progress through to delivery.