Print Order Form, Complete and MAIL to the address below,
or FAX Toll-Free to 1-877-241-5670

Customer Name:

Home Address*:


City:					State:			Zip:

E-Mail Address:

Home Phone:

Business Phone:


* For security purposes, we must ship orders
to the same address as the credit card company
bills to.  If you need shipment to another
address, contact your credit card company and
have them add an alternate shipping address
approval to your account (You only have to 
do this once).

Type of Card:		MasterCard		Visa			Discover		(circle one)

Credit Card Number:

Expiration Date:

Name As It Appears On Card:

Name of Bank Issuing Card:

Bank Customer Service Number:
(Usually on back of card)

	CIGAR BRAND	DESCRIPTION		# CIGARS	PRICE	EXTENSION

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

(MINIMUM TOTAL ORDER 25 CIGARS)

					MDSE. SUBTOTAL: 					
					UPS SHIPPING:					6.00
					NC RESIDENTS ADD 6% SALES TAX:	

					TOTAL:							$