First Name *

Last Name *

Phone Number *

Company Name 

Street Address *

Address Line 2 

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)

Town / City *

Postcode / ZIP *

Do you have a website? 

Number of Physical Locations *Online Sales only1 store2 stores3 storesmore than 3 locations

Upload a copy of your Resale Permit *
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx

First Name *

Last Name *

Phone Number *

Company Name 

Street Address *

Address Line 2 

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)

Town / City *

Postcode / ZIP *

Do you have a website? 

Number of Physical Locations *Online Sales only1 store2 stores3 storesmore than 3 locations

Upload a copy of your Resale Permit *
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx

First Name *

Last Name *

Phone Number *

Company Name 

Street Address *

Address Line 2 

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)

Town / City *

Postcode / ZIP *

Do you have a website? 

Number of Physical Locations *Online Sales only1 store2 stores3 storesmore than 3 locations

Upload a copy of your Resale Permit *
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx

First Name *

Last Name *

Phone Number *

Company Name 

Street Address *

Address Line 2 

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)

Town / City *

Postcode / ZIP *

Do you have a website? 

Number of Physical Locations *Online Sales only1 store2 stores3 storesmore than 3 locations

Upload a copy of your Resale Permit *
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx

First Name *

Last Name *

Phone Number *

Company Name 

Street Address *

Address Line 2 

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)

Town / City *

Postcode / ZIP *

Do you have a website? 

Number of Physical Locations *Online Sales only1 store2 stores3 storesmore than 3 locations

Upload a copy of your Resale Permit *
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx