Wholesale Registration Form

Wholesale Registration

Complete the form below to sign up for our wholesale account access.
Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Upload Business License.

EIN, Sales Tax ID etc.
Cancelof
eCig Permit.

eCig permit or related permit by your state.
Cancelof
Others

Any other documents
Cancelof
Membership Type

DistroWholesaleRetail
Preferred way to contact

PhoneEmailAny
Membership Rules
I have read, understood, and accepted the rules for wholesale membership.
Privacy Policy
Please reach out and read our Privacy Policy in order to understand how your information is used and shared, and check below if you accept the policy.
I have read, understood, and accepted the PRIVACY POLICY for membership.
Signature

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Once you submit your application, we will contact you shortly to complete your membership application.

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Wholesale Registration