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Signature Release Form

AUTHORIZATION FOR DRIVER RELEASE WITHOUT SIGNATURE


 I, (Print Name) _________________________________________ hereby

 authorize UPS to deliver my packages whether or not I am available to sign

for receipt. I am 18 years of age or older and I am fully aware that by giving

permission for this, I am releasing both UPS and National Cigar Store from

responsibility for the package after delivery. If my package is lost or stolen,

I understand that this authorization waives my right to file any claim for

replacement or reimbursement.


 Signature: _______________________________________________

 Date: ___________________________________________________

 Customer/Sale # __________________________________________

 
 Please mail or fax this authorization to:


 National Cigar Store
 617 Sycamore St
 Waterloo, IA 50703

 Attention: Customer Service / Shipping
 Fax: (319) 234-5958

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