Statewide Distributors

Statewide Distributors - Customer Registration

Get your free Statewide Distributors account now.

Customer Registration Form

Business Information

Legal Business Name :

Address :

City :

State :

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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Statewide Distributors - Customer Registration

Customer Registration Form

Business Information