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Wholesale Sign Up/PACT Act Compliance

Please complete this form and attach the required documents. This form doubles as required PACT ACT Compliance documentation. Once you hit submit please allow us 24-48 business hours to verify your information. Once approved you will receive an e-mail with instructions for setting up your new wholesale account password. Your username will be the email you provide with this submission. We are so excited to have you join the Vape Daugz Family! We will take great care of you!

First Name

Last Name

Position

Registered Business Name

DBA

Tax ID/EIN

State Tobacco License

Business Street Address

City

Zip Code

State

Business E-Mail Address

Best Contact Number

Preferred Method of Contact

Drivers License/State ID

State Issued Business License

State Issued Tobacco License