COMPANY NAME:

NAME OF PREMISES:

ADDRESS:

NO OF EXISTING LICENSEES:

DO YOU ANTICIPATE APPLYING FOR A
LATER CLOSING HOUR:

yes no

IF "YES" ON WHICH DAYS OF THE WEEK
AND FOR HOW LONG

DO YOU CURRENTLY HAVE A PEL:

yes no

IF "NO" WILL YOU BE SEEKING TO
PROVIDE ENTERTAINMENT IN FUTURE:

IF "YES" DO YOU ANTICIPATE MAKING
ANY CHANGES TO YOUR OFFER:

yes no

WILL YOU BE MAKING ANY OTHER CHANGES
TO YOUR BUSINESS AS A RESULT OF
LICENSING REFORM?
PLEASE PROVIDE ANY ADDITIONAL DETAILS