Factory Direct Imports & Cigars

Cigar Club Registration Form

Selection 1		QTY
	Ship to Address
* Name
* Address
* City,State
* Zip
* Phone
* Email
Comments
	Payment Method
* Payment Type	Money Order Credit Card
	If you selected Money Order Please mail payment to: Factory Direct Cigars P.O. Box 15375 Rio Rancho, NM 87174 *(All orders placed with Money Order will be shipped once the Money Order is received.)*
Credit Card Information	Visa MasterCard Discover AMEX
Name As On Card
Card Number
Expiration Date
CVV Number What is this?
Address for Card	Same as Ship To:
Street
City / State
Zip Code
Phone Number
* I am at Least 18	Yes, I am at least 18 years old.
* Enter Date Of Birth
Shipping Method
	If you are paying by credit card please note: Your credit card will not be charged until we verify your information and our stock. We will then process the transaction and email you the receipt along with shipping info.
Mailings	YesNo

Prices subject to change without notice. Not responsible for typographical errors. We reserve the right to limit quantities.

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