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Request to Serve Alcohol at Centennial Commons

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I am requesting approval to serve alcohol (wine and/or beer, only) during the event scheduled for .

Yes, I have contracted with a vendor that has a liquor permit to serve alcoholic beverages, have a bartender(s) for the event, and am providing non-alcoholic beverages and food for guests and transportation for those who need it when leaving the event.

Vendor serving alcohol is

Vendor’s address

Vendor’s phone number

Vendor’s email

I have received and read ATSU’s policy on serving alcohol in the Commons.

My name below indicates that I agree to the terms and conditions given to me and that I am authorized to accept them on behalf of the company or organization listed.

Your Name

Today's Date

On behalf of (company/organization)

Phone number




Department of Student Affairs
A.T. Still University
800 West Jefferson Street
Kirksville, MO 63501
Phone:  660.626.2236
Fax:  660.626.2481