Name: ______________________________________________
Address:_____________________________________________
City:________________________________________________
State:_______________________________________________
Zip Code:____________________________________________
Phone #: ____________________________________________
Brand Needed:________________________________________
How Many Carton's:____________________________________
Email Address:________________________________________
Please attach your check made out to
SMOKES FOR CHEAP
Here
Do Not Cancel This Check Or Stop Payment
Simply Keep This Check For Your
Reciept.
Thank you
By Signing below i state that i am 18 years
of age or older and authorize payment in the form of check draft from the
check above and my signature on this for. I agree to hold smokes for cheap
harmless for any and all damages incured by said draft being printed and
authorize my finacial instatution to pay this ammount on the check above.
Should the check be returned NSF or STOP PAYMENT i authorize Smokes for
cheap to charge me an extra $20 bounced check fee.
X________________________________________Date___________________________
(SIGNATURE OF PERSON ORDERING AND TODAYS
DATE)