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Wholesaler:_______________________________________________________ License No:_______________________

Please send the following quantities of Nevada cigarette tax stamps on __________________________________________
                                                                         (Date)
____________________________via our direct bill account number: __________________________________________

( ) United Parcel Service ( ) Airborne Express ( ) Federal Express ( ) Other ______________________________

All stamp orders will be sent overnight delivery unless otherwise specified. Billing invoice will be sent with the
stamp order.

Attention: _________________________________________

Name:_____________________________________________________________Phone:___________________________

Address:____________________________________________________________________________________________

City:__________________________________________ State:_____________________ Zip:__________________


Fuson Stamp (1’s) :
    No. Boxes           No. Boxes                                                         Value of Stamps

    _________           _________                                            at $.04 each _____________

                                                                  Less 0.5 percent discount _____________

                                                                  Total amount for 1’s ______________


Fuson Stamp (20’s) :
   No. Rolls / Sheets   No. Stamps                                                         Value of Stamps

      _________         _________                                             at $.80 each _____________

                                                               Less 0.5% or .005 discount _____________

                                                                  Total amount for 20’s     _____________


Fuson Stamp (25’s) :
     No. Rolls          No. Stamps                                                          Value of Stamps

     _________          _________                                           at $ 1.00 each _____________

                                                                  Less 0.5 percent discount _____________

                                                                  Total amount for 25’s     _____________


Tribal Stamps (No Charge)                                    TOTAL AMOUNT
      No. Rolls       No. Stamps                             OF THIS PURCHASE
                                                             ORDER                        $________________
      __________         __________


_______________________________________________________                ________________________________
Authorized Signature ( Signature on File)                              Date

Mail or fax to: Cigarette stamp order, Attn: Jodie Tonkin, Department of Taxation, 1550 E. College Parkway
Carson City NV 89706. Fax No. 775-684-2020. Business No. 775-684-2129.

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tax.state.nv.us documents Fuson Stamp Order Purchase

  • 1. Wholesaler:_______________________________________________________ License No:_______________________ Please send the following quantities of Nevada cigarette tax stamps on __________________________________________ (Date) ____________________________via our direct bill account number: __________________________________________ ( ) United Parcel Service ( ) Airborne Express ( ) Federal Express ( ) Other ______________________________ All stamp orders will be sent overnight delivery unless otherwise specified. Billing invoice will be sent with the stamp order. Attention: _________________________________________ Name:_____________________________________________________________Phone:___________________________ Address:____________________________________________________________________________________________ City:__________________________________________ State:_____________________ Zip:__________________ Fuson Stamp (1’s) : No. Boxes No. Boxes Value of Stamps _________ _________ at $.04 each _____________ Less 0.5 percent discount _____________ Total amount for 1’s ______________ Fuson Stamp (20’s) : No. Rolls / Sheets No. Stamps Value of Stamps _________ _________ at $.80 each _____________ Less 0.5% or .005 discount _____________ Total amount for 20’s _____________ Fuson Stamp (25’s) : No. Rolls No. Stamps Value of Stamps _________ _________ at $ 1.00 each _____________ Less 0.5 percent discount _____________ Total amount for 25’s _____________ Tribal Stamps (No Charge) TOTAL AMOUNT No. Rolls No. Stamps OF THIS PURCHASE ORDER $________________ __________ __________ _______________________________________________________ ________________________________ Authorized Signature ( Signature on File) Date Mail or fax to: Cigarette stamp order, Attn: Jodie Tonkin, Department of Taxation, 1550 E. College Parkway Carson City NV 89706. Fax No. 775-684-2020. Business No. 775-684-2129.