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2. Village of Elm Grove 2022 Liquor License Application

   You are applying for the July 1, 2022 to June 30, 2023 Liquor License. The application, forms from the DOR, and fee must be completed in order to be approved. There is a space below for Cigarette License upload and Dance Hall Information if you need to apply - no separate application is needed. Licenses are on a first come, first served basis. Licenses will be EMAILED TO THE APPLICANTS once approved. No licenses will be sent in the mail. The license must be placed in a visible area.

3. APPLICATIONS DUE April 1st

5. Please fill out the entire form before submitting. Any incomplete applications will receive an email denial with reason. Note: if there are any outstanding invoices due to the Village or the County, you may not be approved until those invoices are paid in full. Complete payment should be mailed to the Clerk's office at 13600 Juneau Blvd, Elm Grove WI 53122. NEW IN 2022 - CREDIT CARDS ACCEPTED. Use the link in the submission page to make your payment. Please include $5.00 for publication.

7. This Liquor License application is for...*
9. And we are applying for a...*

   1. Class "A" Beer ($100.00)
   2. Class "B" Beer ($100.00)
   3. "Class C" Wine ($100.00)
   4. Cigarette ($100.00)
   5. "Class A" Liquor ($500.00)
   6. "Class B" Liquor ($500.00)
   7. Reserve Class "B" Liquor* ($10,000 yr 1 - $500.00 thereafter)
   8. Entity Exchange
   9. Class "B" Winery
   10. Class "A" Cider

   There is a $5.00 publication fee for every application. Example Fee: Class B Liquor, Class B Beer, and publication. Total $605.00
10. Disclaimer
    The Village would like to collect the payment for your license in full at the time of the application. We understand we cannot make that a condition of your license. It does however speed up the process by which you receive your license.
12. State Forms
    State forms are required for this application. Below are links to the required State Forms. You must print off the most recent version (linked), fill them out, sign them, and upload them. You do not need to upload individually. A copy of your sellers permit is also required.
14. DOR Forms Page
    https://www.revenue.wi.gov/Pages/Form/alcohol-Home.aspx
15. *You must include your Sellers Permit Number and your EIN
17. Upload Checklist*

    1. Original (AT-106) or Renewal (AT-115) Application
    2. Agent Appointment (AT-104) - only if changing agents from last year
    3. Aux Questionnaire (AT-103)
    4. Seller's Permit (most recent)

    Note: the forms from the DOR DO NOT SAVE unless you choose the option "with markup". Electronic signatures are acceptable.
18. Upload Completed Paperwork*
20. If you need another upload, use this space.
21. If you need another upload, use this space.
23. Agent Appointment*

    1. My agent is the same as last year. (you do not have to fill out a new form)
    2. I have a new agent and will submit the form.
24. New Agent Form (if needed)
26. Other Licenses
    If you are not applying for a Cigarette License or a Dance Hall License, you may skip this section.
28. If you are also applying for a Cigarette License, please upload as part of your liquor application. Fee: $100.00
29. DOR Link Cigarette Application
    https://www.revenue.wi.gov/Pages/HTML/formpub.aspx
30. DOR Link to all Tobacco Applications
    https://www.revenue.wi.gov/Pages/Form/CigTobVapeForms.aspx
32. If you are applying for a Dance Hall License, please check where the dancing will take place.

    1. Dancing will take place inside of the building only.
    2. Dancing will take place inside of the building and outside on the premises.

    The Dance Hall License is an additional $25. This must confirm with what you have listed on your Business Plan of Operation with the Village.
34. Liquor License Premise Description
    This information is required by the State.
36. Our Liquor will be stored...*
    What you list will appear on your license.
38. Our liquor will be sold...*
    What you list will appear on your license. This must confirm with what you have listed on your Business Plan of Operation with the Village.
39. If you have special events, please include the name of the event or the date if you wish to have it be included in your description.
    Example: Night Out 2020 on the patio, Art Walk 2020 in the parking lot.
41. Our invoices will be located...*
    What you list will appear on your license.
43. Wholesaler Contact Information
    Please include s list of current wholesalers for your business. If you have more than 3, please upload a list in the space below.
45. Company Name
46. Contact Name
47. Contact Phone
48. Contact Email
50. Company Name
51. Contact Name
52. Contact Phone
53. Contact Email
55. Company Name
56. Contact Name
57. Contact Phone
58. Contact Email
60. Upload Wholesaler List (if needed)
    Must include Company Name, Contact Name, Contact Phone, Contact Email.
62. Licensed Operator's List
    Please include a list of current licensed operators for your business. If you have more than 8, please upload a list in the space below.
74. Licensed Operator List Upload (if needed)
78. ACKNOWLEDGEMENT
    By submitting this document, you acknowledge the following: I understand I must pay the license fee in full if I wish to have a liquor license assigned to my business. I understand I can have no outstanding bills with the Village of Elm Grove and possibly Waukesha County. I understand the agent information is subject to a background check, a legal notice for the license is placed in the paper, and the Village Board must approve the license application before the Clerk can send me my license. I understand if I hold a reserve license, my license does not come with me if I move my business to another location. I understand I cannot sell my liquor license to someone else; they have to apply through the Village and I either relinquish my license within the year or when I do not pay for my license the following year, it will revert back to the Village.
80. I would like my license emailed to...*
81. The parent company would also like a license emailed to...
83. Contact Name for the License Application*
84. Contact Phone*
86. No paper licenses will be mailed out except upon written request. Licenses must be displayed and be visible from the point of sale.
    If you have a business with a drive up service, please include your outside drive up in your premise description. Note: if you have not already changed your business plan of operation to include the drive up portion as part of your business, you may be operating illegally. Check with the Village Zoning Administrator if you are unsure.
Leave This Blank:


88. 1. Receive an email copy of this form.
89. Email address

    This field is not part of the form submission.

90. Submit

* indicates a required field