PACT Act Registration Form

Wholesale Account Application

Please fill out the form below to submit your information to apply for a wholesale account. As part of recent changes to the PACT Act, we need to prove that anyone we ship to is a legitimate business, is compliant with their local state, county, and city laws, and that we have proof of such on file.

This is what will be needed:

Any document that you are required to possess to lawfully sell ENDS products in your state (this might be a tobacco license, a regular business license, Sales Tax Permit or OTP license you have with the state). It must be current and active.

If you have multiple locations, we will need documentation for each address we ship to.

We require all businesses to submit a FEIN Letter or equivalent federal registration proof.

In order to get an approved wholesale account with Lookah USA Wholesale, you must create your account on the site and submit this form. Once this is complete, you can email us at Wholesale@LookahUSA.com or call us at (833) 4LOOKAH (833-456-5624) to request a review of your information.

Business Information

First Name * Primary Contact

Last Name * Primary Contact

Company Name * Name listed on Tax and Federal documents.

DBA Doing Business As - Alternate name for your company registered with your state.

Primary Business Email * www.lookahusawholesale.com registered email

Phone * Primary location phone number.

Street Address 1 * Street Number and Name - Example: 123 Main St

County * The county in which your business is located.

Street Address 2 Suite or Unit Number - Example: Suite 201A

City * The city in which your business is located.

State * The state in which your business is located.

Zip Code * The Zip Code your business is located in.

How many locations will you need products shipped to? * Must be shipped to business addresses. We will need documentation for all locations that we will ship to.

Required Tax Information and Documentation

State Sales Tax Documentation is required to make your account tax exempt.

Federal Tax ID Number * FEIN Number located on your SS4 form. Example: 12-3456789

Please attach a photocopy of your Federal Tax ID * Example: SS4 form from the IRS. .jpg, .jpeg, .png, and .pdf formats only

Sales Tax Account Number If applicable in your state.

Sales Tax Permit Expiration Date If applicable in your state.

Please attach a photocopy of your Sales Tax Documents * .jpg, .jpeg, .png, and .pdf formats only

State License and Permit Information and Documentation

Please include all that apply in your state, county, or city.

Tobacco License Number If applicable in your state.

Tobacco License Expiration Date If applicable in your state.

Please attach a photocopy of your Tobacco License(s) If applicable in your state. .jpg, .jpeg, .png, and .pdf formats only

Business License Number If applicable in your state.

Business License Expiration Date If applicable in your state.

Please attach a photocopy of your Business License(s) If applicable in your state. .jpg, .jpeg, .png, and .pdf formats only

OTP License Number If applicable in your state.

OTP License Expiration Date If applicable in your state.

Please attach a photocopy of your OTP License(s) If applicable in your state. .jpg, .jpeg, .png, and .pdf formats only

Please include information on any other licenses or permits your state, county, or city requires you to have.

Please attach photocopies of any other licenses and permits your state, county, or city requires you to have. .jpg, .jpeg, .png, and .pdf formats only

Thank you for submitting the required information. If you are creating a new account, please email us at Wholesale@LookahUSA.com or call us at (833) 456-6524(4LOOKAH) to have us review your information for account approval.

Have a great day!

Thank you for submitting the required information. If you are creating a new account, please email us at Wholesale@LookahUSA.com or call us at (833) 456-6524(4LOOKAH) to have us review your information for account approval.

Have a great day!

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