Fillable Order for City of Virginia Beach Cigarette Stamps (City of Virginia Beach)

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Order for City of Virginia Beach Cigarette Stamps (City of Virginia Beach)

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The Order for City of Virginia Beach Cigarette Stamps (City of Virginia Beach) form is 1 page long and contains:

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  • 2 check-boxes
  • 26 other fields

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File type: PDF

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Order for City of Virginia Beach Cigarette Stamps
Commissioner of the Revenue
2401 Courthouse Drive
Virginia Beach, VA 23456-9002
Please print or type all applicable information requested below.
Name
Account Number
(For Office Use Only)
Check Number
________________
Street Address
City
State
Zip
Contact Person
Telephone Number
( )
Quantity Stamps Roll Tax Value Tax Value
1 Rolls (20) (15,000 stamps @ $0.75) @ $11,250 Ea. $
2 Rolls (25) (15,000 stamps @ $0.93) @ $13,950 Ea. $
3 Total Tax Value This Order (Sum of Lines 1 thru 2) $
4 Less 8% Discount $
5 Amount Due (Line 3 minus Line 4) $
6
Amount Paid – Make Check Payable to City of Virginia Beach Treasurer
(Full payment due at point of purchase and must be in the form of cashiers or certified check.*)
002.00002.411501
$
Shipping Instructions (Verify terms with courier.)
C
ourier Name _____________________________________________________________________________
A
ccount Number ___________________________________________________________________________
I
nsurance Required? ☐ Yes ☐ No If Yes, Amount $ ___________________________________________
A
uthorized Signature _______________________________________________ Date ________________________
For Office Use Only:
P
rocessed By ______________________ Date ____________________
R
oll Number(s) Sold __________________________________________
____
_______________________________________________________
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Order for City of Virginia Beach Cigarette Stamps (City of Virginia Beach)

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Completed 4 June 2021

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