Lucky Star Wholesale Customer Application

Lucky Star Wholesale Customer Application
Name of Business / Store Name
XYZ Mart, XYZ Grocery Store.
Name of Corporation
XYZ Corporation.
Store Address

Street Address

Street Address Line 2

CityState

Zip Code
Business Phone Number:
Format: (000) 000-0000.
Mobile Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Reconfirm E-mail
example@example.com
Texas Sales Permit #
Approval Status
Customer ID
Do you intend purchase Cigarette, Tobacco, or E-Cigarette Products?
Texas Tobacco Permit #
Texas Tobacco Expiration Date

MonthDayYear
Date
Texas E-Cigarette Retailer Permit #
Texas E-Cigarette Expiration Date

MonthDayYear
Date
State
Do you intend to use EDI?
Electronic data interchange (EDI) is the automated exchange of documents such as invoices for you to directly upload to your system. Kindly make sure your business is pre-set to receive EDI files.
Select your EDI Type:
E-mail
example@example.com
Reconfirm E-mail
example@example.com
Sales Tax Resale Certificate

Instructions: Please download the form given in the link, fill it out, and then upload it besides.

Click here to download the template
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Attach copies of the following:
1. Texas Use Tax Permit
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2. Texas Sales Tax Permit
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3. Authorized Buyer's Driver's Licenses
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4. Tobacco & Cigarette Permit
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5. Texas E-Cigarette Retailer Permit
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Select Device For Signature
Owner's Signature
Owner's Signature
Owner's Name

First NameLast Name
Designation
Date

MonthDayYear
Date
Should be Empty: