This document is a cigarette tax stamp order form submitted by a wholesaler to Nevada's Department of Taxation. It requests specific quantities of 1's, 20's, and 25's cigarette tax stamps to be delivered by a specified date and shipping method to the wholesaler's listed address. The form provides spaces to fill in the number of boxes/rolls/stamps ordered of each denomination, their total value at the listed prices, applicable discounts, and a signature authorizing the order with the total payment amount.