Customer Information
Retailers only
Cigar Order Form
2026
Name:
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First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Order Details
Additional Notes
Please provide any special instructions below:
Signature
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Date
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Month
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2 digit month, 2 digit day, 4 digit year
Date
My Products
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( X )
King Musa Gold (Box 10)
$70.00
$
70.00
Quantity
1
2
3
4
5
6
7
8
9
10
King Musa Empire Gold (Box 10)
$70.00
$
70.00
Quantity
1
2
3
4
5
6
7
8
9
10
El Negro (Box 20)
$150.00
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
El Negro (5 Pack)
$37.50
$
37.50
Quantity
1
2
3
4
5
6
7
8
9
10
Black Jesus (Box 10)
$70.00
$
70.00
Quantity
1
2
3
4
5
6
7
8
9
10
Black Jesus (5 Pack)
$37.50
$
37.50
Quantity
1
2
3
4
5
6
7
8
9
10
Queen Candace (Box 20)
$140.00
$
140.00
Quantity
1
2
3
4
5
6
7
8
9
10
Shipping
Shipping and Handling
$25.00
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
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