Form Otp 99 - Request To Transport Other Tobacco Products Between Distributors
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2OTP 99
Reset Form
Rev. 4/11
Consent Authorization Number
P.O. Box 530
(Internal use only)
Columbus, OH 43216-0530
Request to Transport Other Tobacco Products Between Distributors
Name of requesting distributor
Account number
Name of person requesting consent
Date to be shipped
Telephone number
Fax number
Name of supplying distributor
Account number
Name of contact person receiving consent
Purchase invoice number
Telephone number
Fax number
Make/model/color of vehicle used for shipment
License plate number of vehicle
PM or NPM
manufacturer
Product description
(indicate MSA status
(all roll-your-own brands must be listed
Manufacturer
separately or attach invoices)
Quantity
if product is RYO)
I declare under penalties of perjury that this request has been examined by me, and to the best of my knowledge and belief
is a true, correct and complete request for transportation of other tobacco products.
Signature
Date
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