Wholesale Account Information & PACT Act Documents
Please use this form to update your PACT Act documents and keep your contact information up to date.
Business Owner Full Name
*
First Name
Last Name
Company Legal Name
*
DBA (if applicable)
Ship to Address
*
Street Address
Street Address Line 2
City
State
Zip Code
E-mail
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Federal Tax ID (EIN)
*
Please provide a copy of your IRS EIN Letter
*
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Please provide a copy of the Business Owner’s current Driver's License
*
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Please provide a copy of your Vapor / Tobacco License
*
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Please provide a copy of your Business License
*
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Please provide a copy of your Sales Tax Certificate
*
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Note:
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