Keg registration form

A retail licensee selling beer in kegs shall fill out a keg registration form which is signed by the purchaser. The form must be in the following format: KEG REGISTRATION FORM VALID ID MUST BE SHOWN ______________________________________________________________________ Instructions (Please Print): NAME: ___________________________________________________________ ADDRESS: ________________________________________________________ PHONE: __________________________________________________________ TYPE OF ID SHOWN AND NUMBER: ____________________________________ KEG NUMBER (To Be Filled In By Retail Licensee): _________________________________________________________________ SIGNATURE OF PURCHASER: _________________________________________ DATE: ___________________________________________________________