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Customer Registaton Form

Register your Business to shop our online wholesale smoke shop. An activation email will be sent after completing this form, along with password to login.

Name*
First Last
Username*
Pick something easy to remember, if not use your email address here
Email*
Phone*
Business License #*
Enter your state given Business License number, or sellers permit #.
upload picture of your Business License/ Sellers Permit*
If using a mobile device, you may take a photo directly from your phone.
Shipping Address*
Street Address Address Line 2 City State ZIP Code

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Customer Registaton Form