Reseller Application Form

Business Information

Company Legal Name *

Company Trading Name *

Company Registration Number *

Contact Person First Name *

Contact Person Last Name

Contact Person Number *

Email address *

Legal Registered Address Line 1 *

Legal Registered Address Line 2

Company City *

Company State *

Postal Code *

SVR Code(Specialist Vape Retailers Code e.g AVP-321)*

SHIPPING INFORMATION

Delivery Address details

Is shipping address same as billing address? *

Yes

No

** All accounts are on a as is Cash term and reviewed by COTD accounts team on a 6 months basis. COTD have the right to approve or decline any credit terms and accounts requested by the customer with a reasonable time period by written notice.

Account Team Information

Your accounts team information that will receive invoices and will responsible to pay invoices.

First Name *

Last Name

Accounts Payable Contact No.*

E-mail *

Sales Representative*