Form Cig-Stamp Fillable Fuson Stamp Purchase Form
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(Date) at $ 04 each at $ 1 00 each at $ 80 each Less 0 25 percent discount Less 0 25% or 0025 discount No Boxes No Rolls No Rolls / Sheets ORDER $ Total amount for 1 s Total amount for 20 s Total amount for 25 s via our direct bill account number: ( ) Federal Express (Attention) (Date) (Fuson Stamp Purchase Order Form) (Less 0 25 percent discount) (Less 0 25% or 0025 discount) (No Boxes) (No Rolls / Sheets) (No Rolls) (No Stamps) (No Stamps) (Phone) (Please send the following quantities of Nevada cigarette tax stamps on) (Taxpayer ID and LOC) (undefined) (undefined) (undefined) (Value of Stamps) (Value of Stamps) Address: All stamp orders will be sent overnight delivery unless otherwise specified Billing invoice will be sent with the Attention: Authorized Signature ( Signature on File) Carson City NV 89706 Fax No 775 684 2020 Business No 775 684 2129 or 775 684 2122 City: State: Zip: Fuson Stamp (1 s) : Fuson Stamp (20 s) : Fuson Stamp (25 s) : Fuson Stamp Purchase Order Form Mail or fax to: Cigarette stamp order Attn: Stamp Order Department of Taxation 1550 E College Parkway Name: Phone: No Boxes No Stamps No Stamps OF THIS PURCHASE Please send the following quantities of Nevada cigarette tax stamps on stamp order Tribal Stamps (No Charge) TOTAL AMOUNT Value of Stamps Value of Stamps Wholesaler: Taxpayer ID and LOC #