Philadelphia Beverage Tax – Dealer Notification

Dealers of Sweetened Beverages are required to provide notification to Distributors that distributions of sweetened beverages to them are subject to the Philadelphia Beverage Tax.

  • Dealer Information - This notification is being provided by:

    By signing this notification form, this confirms that the Dealer has provided notification of the Registered Distributor/Dealer as required under Chapter-4100 of the Philadelphia Code. Please ensure you confirm or change the information for the percentage of Sweetened Beverages intended for retail sale in the City of Philadelphia at the bottom of this form.
  • Filling in your name here will act as signature for this form.
  • Date Format: MM slash DD slash YYYY

  • Distributor Information - This information is being provided to:

  • 6. Distributor Name: Ellis Coffee Company
    7. Distributor Contact: Accounts Payable Supervisor
    8. Distributor Business Location: 2835 Bridge Street, Philadelphia, PA 19137
    9. Distributor Phone: 215-537-9500

  • % of Sweetened Beverages intended for retail sale in the City of Philadelphia

  • If the percentage of products distributed to this Dealer intended for retail sale in Philadelphia is less than 100%, please indicate the correct percentage.
  • This field is for validation purposes and should be left unchanged.