Form Tt-19-Npm - Tobacco Product Manufacturer Certification For Non-Participating Manufacturers Page 7

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Part 7: Stamping Agent Identification
For each Brand Family, list every Stamping Agent (including any distributor, wholesaler or
retailer) that affixes Virginia cigarette excise tax stamps (attach supplemental pages if needed).
Name, Address and Phone
Brand Family(s)
Part 8: Internet and Mail Order Sales (attach supplemental pages if needed)
Company, Website or Domain Name:
Title:
Address:
Phone:
Fax:
Email:
State/Country where Incorporated or Registered:
Total Sales in(to) Virginia for the Previous Calendar Year:
Page 7 of 9

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