Forms

The following forms are to be used for new applications only. DO NOT use these forms for permit renewals. Please fill out completely and mail completed forms and payment to:
Arkansas Tobacco Control
101 East Capitol Ave., Suite 401
Little Rock, AR 72201-3824

All forms below are in PDF format unless otherwise noted.
NOTE: Applications for Vapor Product and Alternative Nicotine Product will not be processed until July 21, 2015 when the new law goes into effect.

Manufacturer
Manufacturer Cigarette Only Permit Application Includes: 
Instructions to obtain a Manufacturer Cigarette Permit
Application for Manufacturer Cigarette Permit
Affidavit for Manufacturer Cigarette Permit 
Application for Manufacturers Representatives' License
Manufacturer Tobacco, Vapor and Alternative Nicotine Products Only Permit Application Includes: 
Instructions to obtain a Manufacturer Tobacco, Vapor Product and Alternative Nicotine Product Permit
Application for Manufacturer Tobacco, Vapor Product and Alternative Nicotine Product Permit
Affidavit for Manufacturer Tobacco, Vapor and Alternative Nicotine Products Permit
Application for Manufacturers Representatives' License
 
Manufacturer Cigarette and/or Tobacco, Vapor Product and Alternative Nicotine Product Permit Application Includes: 
Instructions to obtain a Manufacturer Cigarette and/or Tobacco, Vapor Product and Alternative Nicotine Product Permit
Application for Manufacturer Cigarette Permit
Application for Manufacturer Tobacco, Vapor Product and Alternative Nicotine Product Permit
Affidavit for Manufacturer Cigarette Permit
Affidavit for Manufacturer Tobacco, Vapor Product and Alternative Nicotine Product Permit
Application for Manufacturers Representatives' License
 
Manufacturer's Application for Fire Safe Standard Compliant Cigarette Approval Includes using either one of these sets of forms:
Manufacturer's Application for Fire Safe Standard Compliant Cigarette Approval | PDFEXCEL
 
Retail
Retail Cigarette and Tobacco Permit Application and/or Exclusive Vapor Product and Alternative Nicotine Product Permit Application Includes:
Retail Cigarette and Tobacco Permit Application - Sole Proprietor
Retail Cigarette and Tobacco Permit Application - Partnership, LLC, Corporation
Retail Exclusive Vapor Product and Alternative Nicotine Product Permit Application
Unfair Cigarette Sales Act Letter
Tobacco Server Awareness Form
Special Event Permit
Sales to Minors Sign
Cigarette and Tobacco Inventory Instructions
Cigarette and Tobacco Inventory Form  PDF EXCEL 
Procedure for Selling Damaged or Discontinued Cigarettes
Act 1073 of 2003 - Sale of Brands not on the Attorney General's Approved-for-Sale Tobacco Products Directory
 
Duplicate Permit Request Form Includes:
Duplicate Permit Request Form
 
Wholesale
Wholesale Cigarette Only Permit Application Includes:
Instructions to obtain a Wholesale Cigarette Permit  
Application for Wholesale Cigarette Permit  
Affidavit for Wholesale Cigarette Permit  
Suggested Advertisement for Wholesale Cigarette and Tobacco Permit Affidavit  
Application for Wholesalers Representatives' License
Unfair Cigarette Sales Act Letter  
Act 1073 of 2003 - Sale of Brands not on the Attorney General's Approved-for-Sale Tobacco Products Directory
 
Wholesale Tobacco, Vapor Product and Alternative Nicotine Product Only Permit Application Includes:
Instuctions to obtain a Wholesale Tobacco, Vapor Product and Alternative Nicotine Product Permit
Application for Wholesale Tobacco, Vapor Product and Alternative Nicotine Product Permit
Affidavit for Wholesale Tobacco, Vapor Product and Alternative Nicotine Products Permit
Application for Wholesalers Representatives' License
Suggested Advertisement for Wholesale Cigarette and Tobacco Permit Affidavit
Act 1073 of 2003 - Sale of Brands not on the Attorney General's Approved-for-Sale Tobacco Products Directory
 
Wholesale Cigarette and Tobacco, Vapor Product and Alternative Nicotine Product Permit Application Includes:
Instructions to obtain a Wholesale Cigarette, Tobacco, Vapor Product and Alternative Nicotine Product Permit 
Application for Wholesale Cigarette Permit  
Application for Wholesale Tobacco, Vapor Product and Alternative Nicotine Product Permit  
Suggested Advertisement for Wholesale Cigarette, Tobacco, Vapor Product and Alternative Nicotine Product Permit
Affidavit for Wholesale Cigarette and Wholesale Tobacco, Vapor Product and Alternative Nicotine Product Permit
Application for Wholesalers Representatives' License  
Unfair Cigarette Sales Act Letter  
Act 1073 of 2003 - Sale of Brands not on the Attorney General's Approved-for-Sale Tobacco Products Directory
 
Sales Representatives
Wholesale Sales Representative License Application Includes:
Application for Wholesalers Representatives' License 
Unfair Cigarette Sales Act Letter
 
Manufacturer's Sales Representative License Application Includes:
Application for Manufacturers Representatives' License 
Unfair Cigarette Sales Act Letter
 
Cigarette Vending
Cigarette Vending Permit Application Includes:
Cigarette Vending Machines (Information Sheet)
Application for General Tobacco Products Vending Permit  
Cigarette Vending Machine Stamps Application
Coin Operated Cigarette Machine Operators Bond
 
Application to sell at less than the presumptive cost of doing business
Includes:
Application to sell at less than the presumptive cost of doing business 
 
Additional Forms
Report a Violation
Training Request