Reserved for Office Use (Date/Time Stamp)
LIQ-REG-201 Rev. 1/29/21
LIQUOR COMMISSION
CITY AND COUNTY OF HONOLULU
711 KAPIOLANI BOULEVARD, SUITE 600, HONOLULU, HAWAII 96813-5249
PHONE (808) 768-7300 • EMAIL HLC@honolulu.gov
INTERNET ADDRESS: www.honolulu.gov/liq
CERTIFICATE OF REGISTRATION (LIQUOR CARD)
New Customer Existing Customer
P
lease print, sign and provide all required documentation noted below.
N
ame: ____________________________________ , _________________________________________ , ____________
Last Name First Name M.I.
Social Security #: __ __ __ – __ __ – __ __ __ __
O
ahu Address: ________________________________________________________________ Apt. #: ______________
City: _____________________________________________ , HI Zip Code: _________________________
Phone #: ( ) ___________________________ Email: _________________________________________________
B
irthdate (MM / DD / YYYY): ______________________________
U
.S. Citizen:
Yes No If No, what Country? _________________________________________________
A
lien #: _________________________________________________ Alien Exp. Date: __________________________
E
mployer (Business Name): __________________________________________________________________________
E
mployer’s Liquor License #: __________________ Job Title: _____________________________________________
S
ignature: _________________________________________________________ Date: _________________________
New Customers must provide the following original documents (no copies):
A. Valid Government issued photo ID with Date of Birth (Driver’s License, State ID, Military ID, Passport)
B. Social Security Card or W-2 Form that lists your Social Security Number (Originals ONLY, no copies)
C. Managers/Assistant Managers require a letter from their employer (Form LIQ-TRN-501)
D. $10 Processing fee per liquor card (Pay by Cash or Discover, MasterCard or VISA plus an applicable
service fee. Expect a longer processing time with credit card payment)
Existing Customers must provide all the above, except a Social Security Card or W-2 Form.
For HLC Office Use Only
Yellow Entered in LCIS
Blue Paid
Red
Green
Purple Staff Initial
Score __________
Trainer _________
