Fuson Stamp Purchase Order Form - Nevada Department Of Taxation
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1Fuson Stamp Purchase Order Form
Wholesaler:_______________________________________________________ Taxpayer ID and LOC #__________________
Please send the following quantities of Nevada cigarette tax stamps on __________________________________________
(Date)
____________________________via our direct bill account number: __________________________________________
( ) Federal Express
All stamp orders will be sent overnight delivery unless otherwise specified. Billing invoice will be sent with the
stamp order.
Attention: _________________________________________
Name:_____________________________________________________________Phone:___________________________
Address:____________________________________________________________________________________________
City:__________________________________________ State:_____________________ Zip:__________________
Fuson Stamp (1’s) :
No. Boxes
No. Boxes
Value of Stamps
_________
_________
at $.04 each _____________
Less 0.25 percent discount _____________
Total amount for 1’s ______________
Fuson Stamp (20’s) :
No. Rolls / Sheets
No. Stamps
Value of Stamps
_________
_________
at $.80 each _____________
Less 0.25% or .0025 discount _____________
Total amount for 20’s
_____________
Fuson Stamp (25’s) :
No. Rolls
No. Stamps
Value of Stamps
_________
_________
at $ 1.00 each _____________
Less 0.25 percent discount _____________
Total amount for 25’s
_____________
Tribal Stamps (No Charge)
TOTAL AMOUNT
No. Rolls
No. Stamps
OF THIS PURCHASE
ORDER
$________________
__________
__________
_______________________________________________________
________________________________
Authorized Signature ( Signature on File)
Date
Mail or fax to: Cigarette stamp order, Attn:
Department of Taxation, 1550 E. College Parkway
Stamp Order
,
Carson City NV 89706. Fax No. 775-684-2020. Business No. 775-684-2129 or 775-684-2122.
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