Form Tt-2 - Order For Virginia Cigarette Tax Stamps

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Form TT-2
Order for Virginia Cigarette Tax Stamps
Virginia Department Of Taxation
P. O. Box 1301
Richmond, VA 23218-1301
Please print or type all applicable information requested below.
(For Office Use Only)
Name
Permit Number
Check Number
Street Address
City
State
ZIP
Contact Person
Telephone Number
(
)
Quantity
Stamps
Unit Tax Value
Tax Value
Rolls (20 cigarettes)
1
@ $9,000.00 Ea. $
Dual Rolls (20 cigarettes)
2
@ $9,000.00 Ea. $
Rolls - 8000 (20 cigarettes)
3
@ $2,400.00 Ea. $
Rolls - 7200 (25 cigarettes)
4
@ $2,700.00 Ea. $
5 Total Tax Value This Order (Sum of Lines 1 thru 4)
$
6 Less 2% Statutory Discount
$
7 Net Charge (Line 5 less Line 6)
$
8 Less Credit By Certificates (Form TT-9 must be attached.)
$
9 Plus Bad Debts Recovered
$
10 Amount Due (Line 7 minus Line 8 plus Line 9)
$
11 Amount Paid
$
(Full payment due at point of purchase and must be in the form of cashiers or certified check. *)
* Stamps may be purchased on credit and/or by company check with the posting of a
valid bond or letter of credit. Complete this section only if a bond or letter of credit
is on file with the Department of Taxation.
12
Balance Due Within 30 Days
$
Shipping Instructions (Verify terms with courier.)
Courier Name
Account Number
Insurance Required?
Yes
No
If Yes, Amount $
Authorized Signature
Date
VA Form TT-2 W
REV 8/06

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