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Company Information

Registered Company Name

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Company Registration Number (CIPC)

VAT Number (if VAT-registered)

Type of Business

Phone

• E-mail *

Website Address

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Business Type

Distributor / Wholesaler of Vape Products Retail Vape Store Owner Online-Only Vape Store Both Distributor & Retailer General Retail Store Selling Vape Products Mobile / Pop Up Store Vending Machines

Registered Business Address

Street Address *

City

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ZIP Code

Delivery Address (If different)

Same as Registered Business Address

Delivery Street Address

Delivery Contact Person

Delivery Contact Number

Primary Contact Person

Full Name *

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Mobile Number

Email Address

Accounts / Finance Department

Accounts Contact Person *

Accounts Email Address *

Accounts Telephone Number *

Required Documents Upload

CIPC Registration Document

Director / Owner ID

VAT Registration Certificate (if applicable)

Proof of Business Address

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I confirm that the information provided is true and correct I accept POP Vapor’s Terms & Conditions and Privacy Policy. I consent to receiving invoices and communication via email.

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