HomeMy Public PortalAboutTobacco PermitTOWN OF BREWSTER
2198 MAIN STREET
BREWSTER, MA 02631
PHONE: (508) 896-3701 EXT 1120
FAX: (508) 896-4538
BRHEALTH@BREWSTER-MA.GOV
WWW.BREWSTER-MA.GOV
OFFICE OF
HEALTH DEPARTMENT
APPLICATION FOR RETAIL SALE OF TOBACCO PRODUCTS
FEE: 110.00
Name of establishment:
Address of establishment:
Manager name: Phone #:
Email Address:
Mailing address (if different from establishment):
I, the undersigned, understand my rights and responsibilities in providing tobacco products to the general public
and agree to uphold the laws and regulations set forth by the Town of Brewster Board of Health.
Signed: Date:
Print Name: