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Statewide Distributors - Customer Registration
Get your free Statewide Distributors account now.
Customer Registration Form
Business Information
Legal Business Name :
Address :
City :
State :
Select
AK
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AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip :
Owner :
Phone :
Fax :
Driver License # :
Registrant's email :
State Tobacco License # :
Current Tobacco License :
Expiration Date :
Seller's Permit # :
Seller's Permit :
CA Resale Certificate:
Please use the following link (
https://www.cdtfa.ca.gov/formspubs/cdtfa230.pdf
)to fill up the resale form. Once filled, please download, print and sign it. Then attach a scanned copy of the form with this application.
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