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Montana Department of Revenue Dan Bucks Brian Schweitzer Governor Director SAMPLE REQUEST NABCA Number Vendor Ship to Product Description of Cases Sampling Agency # Number Broker/Representative: Date of Request: _____________________________ Reason for Samples: Please follow the guidelines below: 1. Requests must contain complete NABCA number (i.e. 530-93204-75) 2. When submitting your requests, please use one of the following: Fax: (800) 332-6135 Option 3 – 1 Mail: 2517 Airport Road, Helena, Montana 59601 Email: sswanson@mt.gov Customer Service (406) 444-6900 TDD (406) 444-2830 www.mt.gov/revenue

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