State Liquor Store Supplier Representative Visit Log

Log recording supplier and distributor representative visits to state liquor store locations, covering visitor identification, visit purpose, products or materials provided, compliance attestations, and store manager acknowledgment.

Visit Details

• Store Location / Store Number
  Enter the store name, number, or address where the visit occurred.
• Date of Visit
  Select the date the representative visited the store.
• Arrival Time
  Record the time the representative arrived.
• Departure Time
  Record the time the representative departed (if known).
• Visit Type
  Indicate whether this visit was scheduled in advance or unannounced.

Visitor Information

• Representative Full Name
• Company / Distributor Name
• Representative Title / Role
• Representative Phone Number
  Optional — for follow-up contact if needed.
• Representative Email Address
  Optional — for follow-up contact if needed.
• Distributor / Supplier License Number
  Enter the state-issued alcohol distributor or supplier license number if displayed on credentials.
• Was representative identification verified?

Purpose of Visit

• Primary Purpose of Visit
  Select all purposes that apply to this visit.
• If 'Other', describe the purpose
• Products or Brands Discussed
  Include product names, categories, or SKUs referenced during the visit.
• Additional Visit Notes

Products and Materials Provided

• Were any products, samples, or materials left at the store?
• Items Provided — Description and Quantity
  List each item provided, including type, description, and quantity. Include product samples, POS displays, shelf talkers, printed materials, or any other items.
• Estimated Total Value of Items Provided (USD)
  Provide an estimated combined retail value of all items left at the store. Many state control boards require disclosure of items exceeding a defined threshold (commonly $25–$50).
• Are all items provided compliant with state gift and gratuity restrictions?
  Refer to your state alcohol control board's trade practice rules before answering. If uncertain, consult your supervisor before accepting items.
• Describe the compliance concern

Store Staff Contact

• Store Staff Member Who Received Representative
• Staff Member Role
• If 'Other', specify role
• Store Areas Accessed by Representative
  Select all areas of the store the representative entered or accessed.

Manager Acknowledgment and Sign-Off

• Acknowledging Manager / Supervisor Name
• Date of Manager Review
• Manager Attestation
  By checking this box, the manager confirms that the information recorded in this log is accurate and complete to the best of their knowledge, and that the visit was conducted in accordance with applicable state alcohol control board regulations and store policy.
• Manager Signature
  Electronic signature of the acknowledging manager or supervisor.
• Is any follow-up action required?
• Describe Required Follow-Up Action