Do not write in this space – (Office Use Only)

Order ID:  TC-

(Please Use Dark Ink. No staples or tape on form)

 

Contact Information:    Online Order Form

Phone:

Email :

 

* Enter Your Name & Shipping Address:

 

 

Mailing Instructions:

Send order form with payment to:

TCL Enterprises

12723 Route 438

Irving, NY 14081

Make payment payable to: TCL Enterprises Your Personal Check or Money Order Welcome

 

Priority Mail Shipping & Handling Rates: Up to 5 Cartons - $9.50

BUY 6 0R MORE CARTONS - $1.90 Per Carton

Visit us on the web: internetsmokes.com

 

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Special Instructions

Thank you for your order! Internet Smokes

Sub Total

$

Shipping -

(See Above)

$

TOTAL

$

 

***** THIS SECTION MUST BE COMPLETED EVERYTIME YOU ORDER *****

 

1. Age Verification: (Required By Law):  Existing Customers: Sign your name below.

 New Customers: Sign your name below and send in a COPY of State issued ID (i.e. Drivers License)

I Certify that I and anyone I am ordering for are over my State’s Adult Legal Age:

 

Sign your name here: _____________________________________________________________                                  

 

2. Personal Use Only - Not for Resale Certification: (Required by Internet Smokes)

 (You can buy for family, friends or co-workers, but IT IS Illegal to resell cigarettes to anyone.)

 

I am purchasing cigarettes for my/our Personal Use:  (Circle Answer)     YES    -     NO