PREMIUM CIGAR INTEREST CUSTOMER / DIVISION Are you an NCD Customer (or were a customer of one of our divisions)?Please select... Yes No Not Sure Which NCD Division services or serviced, your store(s)?Please select... Harold Levinson Associates HLA / Farmingdale / Central / Tri-State J Polep / Chicopee / North / New England Allen Brothers / Philly / South / Del Valley Century Distributors / Rockville / Mid-Atlantic Don't Know None Which State(s) are your store(s) in?Please select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico TYPE OF BUSINESS Please select... APPAREL BODEGA BROKER CANDY SHOP CBD / VAPE SHOP CIGAR LOUNGE CONVENIENCE STORE DELI DISTRIBUTOR EDUCATION INSTITUTION HOSPITAL MANUFACTURER MULTI-STORE OPERATOR OFFICE BUILDING RECREATION STORE WITH GAS STATION TECHNOLOGY TOBACCO SHOP VENDOR OTHERIf you have multiple locations choose the majority. Customer / Store Name Customer Account # If you have multiple stores, just put one account # Your First Name Your Last Name Phone # Address Line 1 Address Line 2 City StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Postal Code Email address Do you have a current & active Tobacco licensePlease select... Yes No Not Sure SPECIAL OFFER CODE Have a discount, coupon or promotion code?enter it here INTERESTED IN PREMIUM Do you currently carry PREMIUM CIGARS?Please select... Yes No Which would you like to learn more about? Please select... Countertop Humidor 2' Wide Floor Humidor 4' Wide Floor Humidor Entire Humidor Room "Exclusively" NCD Cigars Tubeaux UnsureSelect all that apply Which are part of your store, if any Please select... Countertop Humidor 2' Wide Floor Humidor 4' Wide Floor Humidor Entire Humidor Room "Exclusively" NCD Cigars Tubeaux UnsureSelect all that apply Per month, what is your cigar (stick count not revenue) projections be per month enter #s only GENERAL QUESTIONS How did you hear about NCD?Please select... Industry Publication / Website Google / Internet Search Event NCD Employee Broker Friend Other Tell us which Industry Publication/Website, Event, Employee, or Broker - so we can thank them! Select all of the delivery services you participate in, if any.Please select... None DoorDash Go Puff GrubHub Lula Postmates Seemless Self-Delivery Uber Eats Other Do you have digital signage/TVs in your store(s)Please select... Yes No Unsure Are you happy with your POS provider?Please select... Yes No I don't have a POS system Unsure Anything else you want to share? Contact Information
