(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 #
