Account Access - Canada Form

Account Access - Canada Form

Nicotine River is requiring the following information on file from your company. If this form is not submitted, you may be unable to purchase nicotine products from our store. This form is for Canada businesses only.
Name *

First Name Last Name
Company Name *
Email *
example@example.com
Phone Number *

Country Code Phone Number
Primary Shipping Address *

Street Address

Street Address Line 2

City Province

Postal Code Country
Please submit your business license or proof of business operations below.

The more licenses provided, the better. Images of the licenses are required.
Licenses & Permits *

Cancel of
Please allow us 24 - 48 business hours to review your form. Once your form has been approved, your account will be activated for nicotine purchases.

For questions or concerns, please email: info@nicotineriver.com
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