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 Only Permit
Application for Manufacturer Cigarette Only Permit 
Affidavit for Manufacturer Cigarette Only Permit 
Application for Manufacturer’s Salesperson Permit  
Manufacturer Tobacco Products and Alternative Nicotine Products Only Permit Application Includes:
Instructions to Obtain a Manufacturer Tobacco Products and Alternative Nicotine Products Only Permit
Application for Manufacturer Tobacco Products and Alternative Nicotine Products Only Permit
Affidavit for Manufacturer Tobacco Products and Alternative Nicotine Products Only  Permit
Application for Manufacturer’s Salesperson Permit  
Manufacturer Vapor Product and E-liquid Product Only Permit Application Includes:
Instructions to Obtain a Manufacturer Vapor Product and E-liquid Only Permit
Application For Manufacturer Vapor Product and E-liquid Product Only Permit
Affidavit For Manufacturer Vapor Product and E-liquid Product Only Permit
Application for Manufacturer’s Salesperson Permit
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 | PDF | EXCEL

Retail
Retail Cigarette and Tobacco Permit Application and/or Exclusive Vapor Product and Alternative Nicotine Product Permit Application Includes:
ATC – R1 2-2020 Retail Application
Unfair Cigarette Sales Act Letter
Tobacco and Vapor Server Awareness Form
Special Event Permit
New Sales to Minors Sign
Cigarette and Tobacco Inventory Instructions
Cigarette and Tobacco Inventory Form PDF | EXCEL
Required Procedure and Form for Selling Discounted Cigarettes
Act 1073 of 2003 – Sale of Brands not on the Attorney General’s Approved-for-Sale Tobacco Products Directory
Vapor Product and E-liquid Product Exclusive Permit (Manufacturer, Wholesaler, and Retailer) Application
Duplicate Permit Request Form Includes:
Duplicate Permit Request Form

Wholesale
Wholesale Permit Tobacco Products, Vapor Products, Alternative Nicotine Products, or E-liquid Products Application Includes:
Instructions to Obtain a Wholesale Permit 
Application for Wholesale Permit
Affidavit for Wholesale Permit
Suggested Advertisement for Wholesale Permit
Application for Wholesaler’s Salesperson Permit
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
Wholesaler’s Salesperson Permit Application Includes:
Application for Wholesaler’s Salesperson Permit
Unfair Cigarette Sales Act Letter
Manufacturer’s Salesperson Permit Application Includes:
Application for Manufacturer’s Salesperson Permit
Unfair Cigarette Sales Act Letter

Tobacco/Vapor/E-liquid/Alternative Nicotine Products Vendor
Vendor Permit Application Includes:
Application for Vendor Permit 
Vending Machine Stamps Application
Vending 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
Instructions for Selling a Retail Store or Cancelling a Permit 
Permit Cancellation Form
Instructions and Form for Selling Discounted Cigarettes 
Product Transfer Form

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