Type of business *Vape StoresGeneral WholesaleConvienience Stores

Legal Business Name *

First Name *

Last Name *

Phone Number *

Address *

Town / City *

Postcode / ZIP *

Country and State *

United States (US)

Select an option…AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)

EIN or Tax ID# *

Upload Resale Certificate 
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx

Upload Business License 
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx

Tobacco License (If Applicable) *
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx

Business Website *

Business Type *OnlineIn StoreBoth

Estimated purchase volume *100-400pcs500-2500pcs3000-5000pcs5000+ pcs

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