Cigaree Stamp Order Form
Orders will be accepted by mail, email or fax only:
Minnesota Department of Revenue
MailStaon3331
600 N. Robert St.
St.Paul,MN55146-3350
Fax:651-556-5236
Email:cigaree.tobacco@state.mn.us
Orders received aer 1:00 p.m., Central Standard Time, will be processed the next business day.
CT211
Rollsx30,000=
Padsx1,500=
Widepadsx1,500=
Quanty 20s Total # of Stamps
Padsx1,500=
Quanty 25s Total # of Stamps
Name Minnesota Tax ID Number
Name of Business
Address
City State ZIPCode
Phone Fax
(Rev.6/19)
Order #:
Stamp Serial #
Begin End
For oce use only
Rollsof20sx30,000=
Padsof20sx1,500=
Padsof25sx1,500=
Quanty Nave American Total # of Stamps
Check One:
UPS Standard Shipping
UPS Code:
UPS Overnight Shipping
UPS Code:
Pick-upme
For morning pick-up, order by 8 a.m.
Foraernoonpick-up,orderby11a.m.
Date:
This is a legal document — a wrien contract for the sale of goods
Pursuant to the Uniform Commercial Code as set forth in Minnesota Statutes, this is a shipment contract. Under this contract, the pur-
chaser bears the risk of loss after, as indicated above by the purchaser, the department either delivers the stamps to the chosen carrier
or the purchaser picks the stamps up directly from the department. In the absence of the purchaser choosing an alternative, the depart-
ment will ship by UPS and the stamps will be insured at UPS’s minimum liability value.
Quesons?Phone:651-556-3035Email:cigaree.tobacco@state.mn.us
