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.

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 Only Permit Application Includes: 
Instructions to obtain a Manufacturer Tobacco Permit
Application for Manufacturer Tobacco Permit
Affidavit for Manufacturer Tobacco Permit
Application for Manufacturers Representatives' License
 
Manufacturer Cigarette and Tobacco Permit Application Includes: 
Instructions to obtain a Manufacturer Cigarette and Tobacco Permit
Application for Manufacturer Cigarette Permit
Application for Manufacturer Tobacco Permit
Affidavit for Manufacturer Cigarette Permit
Affidavit for Manufacturer Tobacco 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 XP | EXCEL 2007
 
Retail
Retail Cigarette and Tobacco Permit Application Includes:
Retail Cigarette and Tobacco Permit Application
Unfair Cigarette Sales Act Letter
Tobacco Server Awareness Form
Special Event Permit
Sales to Minors Sign
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  
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 Only Permit Application Includes:
Instuctions to obtain a Wholesale Tobacco Permit
Application for Wholesale Tobacco Permit
Affidavit
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 Permit Application Includes:
Instructions to obtain a Wholesale Cigarette and Wholesale Tobacco Permit 
Application for Wholesale Cigarette Permit  
Application for Wholesale Tobacco 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
 
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