Application For Tobacco Stamping Permit Form - Alabama Page 2
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2Type or Print Signature Name: __________________________________________________________________________________
Title: ________________________________________________________________________________________________________
Sworn to and subscribed before me this the _________ day of_____________________, ___________.
Notary Public: ________________________________________________________________________________________________
9. Indicate if you are a
Retailer
Wholesaler or
Manufacturer.
10. Are you a licensed tobacco wholesaler in your state?
Yes
No
Permit number: _______________________________________ Cancellation number: __________________________________
11. Are sales of tobacco products in Alabama made only to licensed retail dealers?
Yes
No
12. How many retail stores selling tobacco products are operated in Alabama under your ownership, supervision, or
management? ______________
13. How many sales representatives are employed soliciting orders of tobacco products in Alabama? _____________
14. How will you distribute tobacco products into Alabama?
Company Vehicle(s)
Common Carrier
Mail Order
Other (please explain) ______________________________________________________________________________________
15. How many trucks delivering tobacco products do you operate in Alabama? ______________
16. List counties in which you plan to do business: ___________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
17. We must receive a letter of intent from three (3) of your tobacco manufacturers. These letters must state the manufac-
turer’s intent to sell tobacco products to your company. In addition to the letters from the manufacturers, we require a
letter from your resident state indicating that your company is a duly qualified wholesaler in accordance with all laws,
rules, and regulations with regard to selling tobacco products in the state. These letters must be mailed to our office
directly from the manufacturers and the resident state.
Under penalties of perjury, we hereby certify the above information to be true and correct.
Firm: ___________________________________________________________________________________________________________
Signature: _______________________________________________________________________________________________________
(If you are a LLC, and all members Do Not sign the application, complete form TOB: LLC-AUTH)
Type or Print Signature Name: _____________________________________________________________________________________
Title: ____________________________________________________________________________________________________________
Sworn to and subscribed before me this the ________ day of ________________________, ________.
Notary Public: _________________________________________________
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