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New Account Application (*Required Fields)

Company Name: *

Street Address: *

Addres 2 / Suite

City: *

State: *

Zip Code: *

Contact: *

Contact Email: *

Phone: *

Owner's Name: *

Tobacco License:

Company Email:


Cigar Related References

Vendor / Phone / Account:

1. Vendor: Phone:

2. Vendor: Phone:

3. Vendor: Phone:

4. Vendor: Phone:

The information listed above is for the sole purpose of obtaining credit. I certify that this information is true, and hereby authorize Miami Cigar & Company to investigate the references listed above in regards to the credit and financial responsibility of our firm. My signature affirms the willingness to honor my approved terms and to pay within the specified time.

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