Form 510 - Oregon Cigarette Tax Stamp Order Form - Tax Year 2013 Page 2
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1
2Instructions for ordering cigarette tax stamps
Note: You must use this form in this format for EACH new order.
Complete the Distributor Use area
Deferred customers may fax orders to:
Cigarette Tax, 503-947-2255.
You must fill in your license number, business iden-
Confirm receipt at 503-947-2279.
tification number (BIN), name, shipping address,
city, state, ZIP code, and all courier information.
Please title your fax cover sheet "Attention
If your order is missing information, it may be
Stamp Orders."
returned to you for completion.
The deadline to fax a deferred order is 11:00 am.
1a–5a: Number of stamps. Enter number of each
If you fax your order: When you send the payment
type of stamp ordered in appropriate boxes 1a
with the order form on a previously faxed order,
through 4a. Add amounts in boxes 1a through 4a
be sure to write on the order: “COPY ONLY—DO
and put total in box 5a.
NOT FILL. Order previously faxed.” This will
1b–4b: Number of each. Enter the number of pads
prevent duplicate orders being sent to you.
or rolls ordered in appropriate boxes 1b through 4b.
For customers who want to pick up stamps:
1–4: Total price. Calculate the total price for each
Please remember that your order will be available
type of stamp ordered. Enter the amounts in boxes
for pick up after 1:30 p.m., Monday–Friday.
1 through 4.
Please do not use stamp order forms when only
5: Total order. Add amounts in boxes 1 through 4.
making a payment towards cigarette tax amounts
Enter total in box 5.
owing unless it was a previously faxed order as
6: Calculate discount amount. To calculate your
indicated above.
discount:
Taxpayer assistance
Multiply the Total number of stamps (box 5a) by
the discount rate. The discount rate is $0.004 per
General tax information .....
stamp. Do not multiply the discount rate by the
Tax Services ......................................... 503-378-4988
tax value or purchase price of stamps.
Tax Services:
... 1-800-356-4222
Toll-free from Oregon prefix
Salem Special Programs Admin. Unit ... 503-945-8120
Enter your discount amount in box 6.
Salem tip line ...................................... 503-947-2106
7: Net amount due. Total order amount (box 5), less
Toll-free tip line ...............................1-866-840-2740
discount amount (box 6) equals your net amount
Asistencia en español:
due. Enter the net amount due in box 7. This is the
Salem .................................................... 503-378-4988
amount to pay with your order, or you may defer
Gratis de prefijo de Oregon ...........1-800-356-4222
payment if you have a deferred payment account.
TTY (hearing or speech impaired; machine only):
Mail your order and payment
(payment must be by
Salem .................................................... 503-945-8617
to:
cashier's check or money order)
Toll-free from Oregon prefix ..........1-800-886-7204
Cigarette Tax
Oregon Department of Revenue
Americans with Disabilities Act (ADA): Call one
PO Box 14630
of the help numbers for information in alternative
Salem OR 97309-5050
formats.
150-105-020 (Rev. 12-12)
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