Wholesale Application

Company Name*
Enter Company Name

First Name*
Enter Business Owner's Name

Last Name*
Enter last name

Title
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Phone Number*
Enter phone number

Email Address*
Enter email address

Website
Enter your website url

Billing Address

Country*
Choose Country

Street Address
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City
Enter Billing City

Zip Code
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Is Shipping Address Same As Billing?

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Tax ID
Enter Tax ID - Letters & Numbers

More than one Location?
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Upload Copy of Business License
Upload a Copy of Business License. Acceptable Formats: pdf, jpg, jpeg, tiff, doc, docx

Target Demographic

Gender

Age Range(s) (Select all that Apply)

Demographic Experience

Experience

Brand Experience

Personal Vaping Experience

Product Experience

Supplier History

How did you hear about p0t.com?

Preferred Shipping Method

Preferred Transaction Method