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Alcoholic Beverage Control www.ksrevenue.org/abc.h PO Box 3506 Supplier (Kansas Department of Revenue)

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Alcoholic Beverage Control
Phone: 785-296-7015
109 SW 9
th
Street, 5
th
Floor
Fax: 785-296-7185
PO Box 3506
www.ksrevenue.org/abc.h
tml
Kdor_abc.email@ks.gov
Topeka KS 66601-3506
Supplier Permit Application and Agreement Instructions
Requirements to Obtain a Kansas Supplier Permit:
A. Supplier Permit Application and Agreement (ABC-1000).
B. $25.00 Supplier Permit Fee.
C. Copy of your Basic Permit or Brewer’s Notice.
D. If your company is not located in Kansas, you are you are required to file the Irrevocable Consent to Jurisdiction
form (ABC-160) with the Kansas Secretary of State. The Secretary of State’s Office will return to you a copy of
the ABC-160 form that has been stamped “FILED”. You must then provide the ABC with a copy that has been
stamped “FILED” along with the items listed above.
Instructions to Complete the ABC-1000 Supplier Permit Application and Agreement:
Apply and pay online at https://ksabconline.org/ or continue filling out this form and perform the following steps:
1. Check the “New Permit” box if you do not have a Kansas Supplier Permit or if your Kansas Supplier Permit has been
expired for more than 30 days.
2. Answer the questions. If you answer yes to either question, a Salesperson’s Permit must be obtained for the
person in Kansas soliciting sales from Kansas liquor licensees.
3. Check the appropriate “Application Entity Type”, complete, sign and date the Supplier Permit Application and
Agreement form, print your name and title.
4. Make a copy of the completed Supplier Permit Application and Agreement. Retain the copy for your records.
This will serve as your permit.
5. Complete the attached Supplier Permit Voucher by checking the “New Permit” box, enter the name as it appears on
the Supplier Permit Application and Agreement and check the box to indicate your $25 Permit Fee is attached.
Answer the questions in the “New Permits Only” section.
6. Make your check payable to the “Kansas Department of Revenue” and attach it to the completed Supplier Permit
Voucher below.
7. Return the original completed Supplier Permit Agreement, a copy of your Basic Permit or Brewer’s Notice and
$25.00 Supplier Permit fee to the ABC Marketing Unit. Out-of-state applicants, who are applying for a new
permit, must include a filed copy of the Irrevocable Consent to Jurisdiction (ABC-160).
All approved Supplier Permits are posted to the ABC Active Liquor Licensee Database on the ABC website. To
view your permit information, go to: https://www.kdor.ks.gov/apps/liquorlicensee/
To obtain monthly Supplier reporting forms
and
other
information, visit
our website at:
http://www.ksrevenue.org/abcsupper.html
Direct your questions to the Marketing Unit at 785-296-7015 or email to KDOR_ABC.Marketing.Unit@KS.GOV.
Detach and Return with Payment
KANSAS ALCOHOLIC BEVERAGE CONTROL DIVISION
Supplier Permit Fee Voucher
Supplier DBA Name:
New Permit
Attach the following documents:
Copy of your Federal Basic Permit or Brewer’s Notice
Copy of your filed Irrevocable Consent to Jurisdiction (ABC-160)
$25.00 Permit Fee Enclosed (SLFE)
Not required (Company is located in Kansas)
ABC-1000 (Rev. 5/19)
Alcoholic Beverage Control
Phone: 785-296-7015
109 SW 9
th
Street, 5
th
Floor Fax: 785-296-7185
PO Box 3506 www.ksrevenue.org/abc.html
Topeka KS 66601-3506 Kdor_abc.email@ks.gov
SUPPLIER PERMIT APPLICATION AND AGREEMENT
Permit Type (check one): New Permit Not currently in use
Is your company located in Kansas?
No
Yes
Applicant Entity Type (check one): Individual Corporation
Partnership LLC
LLP
Supplier Permit Number (if appliciable)
FEIN
Phone
Supplier DBA Name
Supplier Entity Name
Location Address
City
Zip
Mailing Address
City
Zip
Contact Person
E-mail Address
Does your company use a compliance agency? Yes* No
*If yes, complete the compliance agency information.
Compliance Agency Name
Compliance Agency Mailing Address
Compliance Agency City
Zip
Compliance Agency Contact Person Name
Compliance Agency Phone
The above named Brewer, Importer, Out-of-State Manufacturer or Vendor, hereafter referred to as “supplier”, does hereby
make application for a Supplier Permit to sell alcoholic liquor and/or cereal malt beverage to licensed distributors or non
beverage users in the State of Kansas. In making this application, the above named supplier agrees that:
a. It will not ship, sell, attempt to sell or deliver any alcoholic liquor and/or cereal malt beverage within the State of
Kansas except to a licensed distributor, manufacturer or non-beverage user.
b. It will not ship, sell, attempt to sell or deliver any alcoholic liquor and/or cereal malt beverage to any distributor who
does not possess a franchise for such merchandise; and that all such sales to franchised distributors in the State of
Kansas will be at the same price and without discrimination.
c. It will register each brand of alcoholic liquor and/or cereal malt beverage with the Director prior to making shipments
to distributors in this state.
d. It will register and pay an annual fee in the amount of $25 for each label of alcoholic liquor and cereal malt beverage
proposed for sale in this state.
e. It will submit monthly reports as required by the Director.
f. It hereby appoints the Secretary of the State of Kansas its resident agent and representative authorized to accept
service of any notice or order and that all such acts by the Secretary of State shall be fully binding upon the supplier.
g. It will abide by all the provisions of the Kansas Liquor Control Act and the Rules and Regulations promulgated
thereunder.
Authorized Signature Date
Printed Name Printed Title
MAKE A COPY FOR YOUR RECORDS
If your application is approved, you will receive your permit via email.
FOR OFFICE USE ONLY:
$25 Permit Fee Received Date New Permit Approved Date Expires June 30, 20
Not currently in use Completed by: Date:
ABC-1000 (Rev. 5/19)
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Alcoholic Beverage Control www.ksrevenue.orgabc.h PO Box 3506 Supplier (Kansas Department of Revenue)

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Completed 8 February 2021

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