The last 4 digits of your Social Security Number and your Driver
License information will be used to help verify your identity and age,
and to make sure we don't confuse you with another person. We will
delete it from our records, and this website, once we confirm your identity.
I certify that I am a smoker, at least 21 years old, and want to receive cigarette coupons and / or other
promotional offers in the mail. I understand that giving false information to qualify for these offers may
violate the law.
By typing your name below, you agree that this will represent your
signature for certifying your age. To sign this Certification, please enter
your first and last name as they appear on your Driver License or other