Licensee Forum - Application Form

Contact Details
Mandatory fields
Contact Person:
Position Title:
Address:
Phone:
Mobile:
Email:
Website Address:
Venue Details

Name of Licensed Premises (Trading Name):
Street Address of Licensed Premises:
Licensee's Name:
Type of Licensed Premises:
	Restaurant Hotel Bar Nightclub Bottleshop Other (please specify):
Type of Licence Held:
	Tavern Theatre Nightclub Restaurant Hotel Off-licence Other (please specify):
Capital Host Charter Checklist

Attach your completed checklist to show how you meet the criteria on safety, service and being proud hosts.
Attach Checklist	(Maximum 2Mb. Only DOC and PDF files are accepted.)

Wellington City Council, 101 Wakefield Street, Wellington, New Zealand