Form 336 - Tobacco Tax License Application Page 5
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7Form 336 Page 5
PArT 5: mAnufACTurer’s LiCense
if you are applying for a manufacturer’s license, complete this section. include a copy of your TTB federal manufacturer of
Tobacco Product Permit (mTP) and attach a current wholesale price list for all products being imported/sold into michigan.
Indicate below which type of manufacturer applies to you:
I am on the NAAG list of Participating Manufacturers ( ).
I am a Non-Participating Manufacturer approved to sell tobacco products in the state of Michigan.
I am a Non-Participating Manufacturer operating or allowing another person to operate a
Cigarette Making Machine in Michigan.
I am a manufacturer of Other Tobacco Products, including cigars and hookah.
I am a manufacturer that will have in-state representatives.
If checked, complete and attach the Tobacco Manufacturer’s Representative Permission List (form 4857).
ToBACCo TYPe
(Attach additional sheets if necessary.)
BrAnD fAmiLY of CiGAreTTes, rYo or oTP
CIG
RYO
OTP
CIG
RYO
OTP
CIG
RYO
OTP
PArT 6: VenDinG mACHine oPerATor’s LiCense
If you are applying for a vending machine operator’s license, complete this section. (Attach additional sheets if necessary.)
Number of vending machines in use
Number of vending machines in storage
Total number of vending machines
List below the business names and addresses where each vending machine is located:
1.
2.
3.
PArT 7: TrAnsPorTATion/CArrier informATion
List transportation/carrier name, address, telephone number and contact person for each shipping company used to ship tobacco
in Michigan, inTo Michigan, or export tobacco from this state to an out-of-state destination.
Company Name
Company Address
Telephone Number
Contact Person
Company Name
Company Address
Telephone Number
Contact Person
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