REQUEST FOR ALCOHOLIC BEVERAGE SERVICE
Date of Request ______________
REQUESTER INFORMATION
Name of Event
Date of Event _____________________Time of Event ____________________ Number Attending
Campus Location of Event
Organization ______________________________________________________ Phone
Organization Contact _______________________________________________ Email
Address _______________________________________ City, State _______ Zip
VENDOR INFORMATION
Name of Licensed Vendor __________________________________________ Permit # ______________________
Food Provided per State Code (Reference) ____________________________________________________________
Underage Monitoring per State Code (Reference) ______________________________________________________
_____ (Initial) It is the Vendor’s responsibility to bus/clear/clean tables at the event of single use containers
purchased from their establishement. i.e.: empty beer cans/bottles, bottle caps and can tabs, cups for drinks, stir
sticks, serving napkins, etc.
The MSU-Northern catering staff are not allowed to remove any containers or get alcoholic beverages from the
vendor per catering service policy.
Compliance with state regulations is the sole responsibility of the licensed vendor listed above. The vendor hereby
agrees to abide by these regulations while on MSU-Northern’s campus.
_____________________________________ ______________________________ ________________
Name (Print) Signature Date
AUTHORIZATION
I hereby request permission for alcoholic beverages to be served at the above event. I verify that I (or my designee)
will be present and sober for the entirety of the event.
________________________________ ______________________________ _________________
Name (Print) Signature Date
OFFICE USE ONLY
Approved ___ Disapproved ___
________________________________ _______________________________ __________________
Authorized Building Supervisor (Print) Signature Date
****************************************************************************
Approved ___ Disapproved ___
___________________________________________________ __________________
Chancellor, Montana State University-Northern Date
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