FreakyPreNeur Cigars Wholesale Dealer Application

FreakyPreNeur Cigars Wholesale Dealer Application

Apply to become a wholesale dealer and authorize payments with FreakyPreNeur Cigars.
Business Information
Business Name
DBA
Business Type
Years in Business
Website
Social Media
Licensing & Compliance
Tobacco License #
State Issued
Tobacco License Expiration Date

MonthDayYear
Date
EIN / Tax ID
Resale Certificate #
Shipping & Billing
Billing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Shipping Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Contact Name
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Payment Authorization
Terms & Conditions
I authorize FreakyPreNeur Cigars to charge approved purchases through Shopify POS, invoices, payment links, or other approved payment methods. Dealer agrees to comply with all tobacco laws and licensing requirements. Past due balances may incur a 1.5% monthly finance charge. Dealer agrees to pay collection costs, attorney fees, and court costs associated with unpaid balances. Wholesale pricing is confidential. Custom band orders become non-refundable once production begins. The undersigned personally guarantees payment of all obligations incurred by the applicant business.
Signature
Business Name
Authorized Representative
Title
Signature
Date

MonthDayYear
Date
Should be Empty: