PRINT THIS PAGE AFTER YOU FILL IT OUT AND SEND IN WITH YOUR I.D. AND PAYMENT
| TOBACCOBYMAIL | ||||||
| PO Box 0025, Salamanca, NY 14779 | ||||||
| Phone: 1-800-419-1907 Fax: 1-716-945-5175 | ||||||
| Please type or print! | Date: | Phone: |
am pm |
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Shipping Address |
We only send to the same address as the credit card billing address. |
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Name: |
(TAPE COPY OF I.D. Here if Paying with M.O. or Check) (First ORDER Only)
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| Address: | ||||||
| City: | ||||||
| State: | Zip: | |||||
| Check Number: | ||||||
| Money orders and checks may be made out to to the address above. Check clearing is 5-7 days. | ||||||
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Order Info |
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| Description
(example- Marlb Menthol Light100 BOX) |
Price per Carton |
Quantity | Total | |||
Total Amount of Order |
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I CERTIFY BY SIGNING BELOW THAT I AM AT LEAST 18 YEARS OF AGE: |
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Sign here X_________________________ |
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Signature Required for processing. |
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GOODS DESCRIBED ARE TO BE TRANSPORTED TO THE ABOVE ADDRESS FOR CONSUMPTION THERE. THEY ARE SOLD TO YOU BY THE TOBACCO BY MAIL COMPANY, WHICH IS AN AUTHORIZED AND EMPOWERED SOVEREIGN ENTITY OF THE SOVEREIGNTY KNOWN AS THE SENECA NATION OF INDIANS. THE SAID GOODS ARE NOT SUBJECT TO INSPECTION, TAXATION, OR SEARCH OR SEIZURE AND ALL RECORDS ARE THE PROPERTY OF THE SAID SOVEREIGNTY AND ARE TO BE KEPT AT THE SAID SOVEREIGNTY'S TERRITORY AND ARE NOT SUBJECT TO INSPECTION, SEARCH , SEARCH, SEIZURE, OR SUBMITTED TO, FOR OR BY ANY AGENCY, STATE, NATION, OR COUNTRY WITHOUT THE WRITTEN CONSENT OF THE SENECA NATION OF INDIANS. |
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Print this page, tape a copy of your I.D. to the spot indicated, copy it, sign it and Fax or send it in.