Form Ct-108 - Wisconsin Cigarette Stamp Order Form For Credit Sales - Sample - 2007

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Form
IMPORTANT: This form can only be
Wisconsin Cigarette Stamp Order Form for Credit Sales
CT-108
used on shipments you will receive
Transmit your order by noon (CST) for same day processing
Wisconsin
July 1, 2007 through June 30, 2008,
Department of
Fax: (608) 327-0228
E-mail: cigarettestamporders@mail.wisconsin.gov
Phone: (608) 266-3282
or until further notice.
Revenue
Pick Up or Express Mail: 2135 Rimrock Rd., Mail Stop 3-258, Madison, WI 53713
Permitted Shipping Address:
Contact Information:
Your Wisc. Cigarette
MYERS-COX CO
Name:
ANITA HEIM
Permit Number:
ATTN: ANITA HEIM
E-Mail:
Out of office till 6/30
S a m p l e
FCD-
23
8797 KAPP DS a m p l eS a mS a m p l e p l eR
Phone:
(563) 583-8200
Extension:
209
Order Date:
PEOSTA, IA 52068
(563) 583-4011
Fax:
This form is personalized to permit holders only
Comments:
Enter Stamp Receipt Date Here:
For office use only
Check Desired Type of Delivery:
UPS Ground (By End of 1 Business Day)
Issue Date:
UPS Next Day Air Saver (By 3:00 pm)
UPS Next Day Air (By 10:30 am)
Filled By:
Pay and report this receipt on return
UPS Next Day Air, Early AM (by 8:00 am)
due 15 days after the end of the month
Checked By:
of the date shown above.
Column A
Column B
Column C
Column D
Beginning
Serial
Ending
Unit
Unit
Serial
Numbers
Serial
Carton
Item
Stamps
Units
Total Stamps
Tax Value Per
Gross Value of
Printing
Printing Cost
Number
Not In
Number
Pack Size
Layout
Descri
Per Unit
Ordered
Ordered
Unit
Stamps Ordered
Cost
this Order
Issued
Circulation
Issued
(Col. A x B)
(Col B x C)
(Col. B x D)
Reg. 20's
2 x 5
Rolls
30,000
$23,100.00
$19.80
2 x 5
Pads
1,500
$1,155.00
$4.49
1 x 10 (Wides)
Pads
1,500
$1,155.00
$5.48
Total Reg. 20s
Reg. 25's
2 x 4
Rolls
7,200
$6,930.00
$5.47
1 x 10 Rolls
4,800
$4,620.00
$3.36
1 x 10 Pads
1,500
$1,443.75
$4.49
Total Reg. 25s
Tribal 20's
2 x 5
Rolls
15,000
$11,550.00
$9.90
Tribal 25's
1 x 10 Pads
1,500
$1,443.75
$3.90
Transfer order information to your monthly CT-104
Total Gross Value of Stamps:
Total Printing Cost:
Incurred Shipping Cost:
Schedule of Purchases for the month that you received
these stamps.
Wisconsin Department of Revenue
CT-108 (R.6/07)

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