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New York State Liquor Authority

In order to create a new account, you must complete the following form. The 'Principal' first name, last name and zipcode must match ONE of the 'Principals' listed on the license registered with the state.

Fields marked with a * are required.

Serial Number:
Certificate Number:
Principal First Name:
Principal Last Name:
Principal Year of Birth:
Principal Home Zipcode:

Disclaimers l Confidentialityl Privacy l Security
New York State Liquor Authority • 80 S. Swan Street • 9th Floor • Albany, New York • 12210-8002