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Company Information

Registered Company Name

Trading Name (if applicable)

Company Registration Number (CIPC)

VAT Number (if VAT-registered)

Type of Business

Phone

• E-mail *

Website Address

Facebook

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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

Province

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 *

Designation / Job Title

Mobile Number

Email Address

Accounts / Finance Department

Accounts Contact Person *

Accounts Email Address *

Accounts Telephone Number *

Required Documents Upload

CIPC Registration Document

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Director / Owner ID

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VAT Registration Certificate (if applicable)

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Proof of Business Address

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