Name:
CALL TOLL FREE
Ship To Address: (if different than Billing Address)
State: Zip:
MERCHANDISE TOTAL
COLOR / WRAPPER QUANTITY SIZE
SHIPPING AND HANDLING (via UPS Ground) : Add $7.95
Free Shipping on selected items
SHIPPING TO ALASKA, HAWAII, VIRGIN ISLANDS, PUERTO RICO
AND ALL PRIORITY MAIL: Add $12.90
3 DAY DELIVERY: Add $15.00
2 DAY DELIVERY: Add $25.00
ALL FL SHIPMENTS: Add 6% Tax and appropriate County Tax
Signature
ORDER FORM
Check or Money Order Enclosed (payable to Luis Martinez Cigar Co.)
Card Number VISA
MC AMEX DISCOVER
Name on Card
CVV Code: Exp. Date:
Billing Address: (must match credit card address)
Business Name:
Address:
Address:
City: State: Zip:
Daytime Phone:
Email:
Please include phone number in case there are questions about your order.
By responding to this offer and signing below, I certify that
I am 21 years of age or older. Your order will not be processed
without signature and date of birth.
Mandatory Signature
Date of Birth
Month/Day/Year
FOR QUICKER SERVICE
PAGE NO. ITEM NO. PRODUCT
METHOD OF PAYMENT
SUBTOTAL
TOTAL AMOUNT OF ORDER
! "
#
$
%&
'
(
$
MAIL COMPLETED FORM IN SUPPLIED ENVELOPE OR ORDER ONLINE AT WWW.LUISMARTINEZ.COM
PRICE TOTAL
Name:
Business Residential
Business Name:
Address:
Address:
City:
Daytime Phone:
WWW.LUISMARTINEZ.COM
PHONE 1-800-822-4427
FAX
or 1-813-248-4175
)*+'+,-
. /(01
/ Vol. 2 / Luis Martinez / Page No. 23
P.O. BOX 76061
TAMPA, FL 33675
/WWW.LUISMARTINEZ.COM
/WWW.LUISMARTINEZ.COM