Application for Town of Gypsum Tobacco Product Retail License

Town of Gypsum Tobacco Product Retail License Application

Business Name: (required)

Retail Address:

Street Number and Name (required)

Unit Number

City (required)

State/Province/Region (required)

Postal/ZIP Code (required)

Retail Phone: (required)

Your Signature

Street Number and Name (required)

Unit Number

City (required)

State/Province/Region (required)

Postal/ZIP Code (required)

Authorized Phone: (required)

Authorized Email: (required)

Primary Applicant's Name: (required)

Primary Applicant's Address:

Street Number and Name (required)

Unit Number

City (required)

State/Province/Region (required)

Postal/ZIP Code (required)

Primary Applicant's Phone: (required)

Primary Applicant's Email: (required)

Secondary Applicant's Name:

Secondary Applicant's Address:

Street Number and Name

Unit Number

City

State/Province/Region

Postal/ZIP Code

Secondary Applicant's Phone:

Secondary Applicant's Email:

Additional Applicants:

Please type your full name below:

There was a problem saving your submission. Please try again later.

Please wait while your submission is being saved...

Thank you, your submission has been received.

License shall be valid from January 1 through December 31 of the year for which it is issued.
License fee $50.00 (new applications) $25.00 (renewals) – Make checks payable to the Town of Gypsum.
Any business offering retail tobacco products for sale in the Town of Gypsum must comply with the following requirements:
- a) License Required. A separate License is required for each retail location within the Town where Tobacco Products are sold.
- b) Display of License. Each Tobacco Product Retail License shall be prominently displayed at the Licensed Premises in a publicly visible location.
- c) Minimum Legal Sales Age. Tobacco Products shall not be sold or offered for sale to any person under twenty-one (21) years of age.
- d) Minimum Legal Sales Age Signage Requirements. Signage is required to be prominently displayed at all entrances to a Licensed Premises indicating that Tobacco Products shall not be sold to any person under twenty-one (21) years of age.
- e) Self-Service Displays Prohibited. The sale of Tobacco by means of a Self-Service display is prohibited.
- f) Packaging and Labeling. Tobacco Products may not be sold to any Consumer unless such product is sold in the original Manufacturer’s Packaging intended for Sale to Consumers; and conforms to all applicable federal Labeling requirements.
- g) Positive Identification Required. No Licensee shall sell or transfer any Tobacco Product to an individual who appears to be under the age of thirty (30) years without first examining the government-issued photographic identification of the recipient to confirm that the recipient is at least the Minimum Legal Sales Age.
- h) False and Misleading Advertising Prohibited. A Tobacco Product Retailer without a valid License, including a Tobacco Product Retailer whose License has been suspended or revoked shall not engage in any of the following, which shall constitute Tobacco Product Retailing without a License:
  1. The display of any Tobacco Product in public view; and
  2. Any advertising, including but not limited to displays, that promotes the sale or distribution of any Tobacco Product that could lead a reasonable Consumer to believe that such products can be obtained.
- i) Fixed Location. The application must include a fixed location for Tobacco Product Retailing. Licenses will not be granted at a location other than a fixed location. Mobile sales of Tobacco Products is prohibited within the Town.
- j) Under-Age Applicant. The applicant must be at least as old as the Minimum Legal Sales Age.

By typing your full name below, the Tobacco Product Retailer listed above and its representative(s) agree to
comply with all the requirements set forth in the Town of Gypsum Ordinance 10 (Series 2019),
governing the licensing and sales of Retail Tobacco products in the Town of Gypsum.