Cigarette Wholesalers & Other Tobacco Wholesalers, Cigarette Importer, Cigarette Manufacturer License Application
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5Wyoming Department of Revenue
Cigarette Wholesalers & Other Tobacco Wholesalers, Cigarette
Importer, Cigarette Manufacturer License Application
An application and license is required for each business location.
A Ten dollar ($10.00) License Fee must accompany each application.
Remittance to be made payable to: Department of Revenue
Excise Tax Division
Herschler Building
Department Use Only:
th
122 West 25
Street
License No:____________________
Cheyenne, WY 82002-0110
Phone: (307) 777-5542
Date Issued:____________________
Web site:
Date Business began Wholesaling Cigarettes & or Other Tobacco Products in Wyoming: ______________
Wyoming Sales Tax License Number: _______________________
Business Name or DBA: ____________________________________________________________________
Business
Location: ________________________________________________________________________________
Street Address
City: ____________________________________ State: __________________ Zip: ___________________
Business Phone Number: (______) ______- _________ Fax Number: (______) ______- _________
Mailing Address if
Different From Above: _____________________________________________________________________
Type of Ownership: Individual
Partnership
Corporation
Association or Other _____________
Ownership Name __________________________________________________________
(Specify)
1. Will you be purchasing unstamped cigarettes directly from a manufacturer for sale or resale in
Wyoming? Yes
No
2. Are you a cigarette importer who imports into the United States either directly or indirectly a finished
cigarette for sale or distribution in Wyoming? Yes
No
3. Are you a cigarette manufacturer who manufactures, fabricates, assembles, processes or labels a
finished cigarette for sale in Wyoming? Yes
No
4. Will you be purchasing cigars, snuff, or other tobacco products directly from a manufacturer for sale
or resale in Wyoming? Yes
No
5. Do you sell at retail stamped cigarettes or other tobacco products directly to Wyoming consumers?
Yes
No
If yes, indicate your Wyoming Sales/Use Tax License Number ___________________
The application shall be signed by: The Owner, if business is a sole proprietorship. All partners, if the
business is a partnership. Member or manager if LLC. One major officer if corporation. Corporations
must attach a complete list of officers. Limited liability companies must attach a complete list of
members or managers.
Signature:_______________________________________________Title:_____________________________
ETS Form 002(revised 05/12/08)
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