PACT ACT WHOLESALE FORM

The Federal PACT Act requires distributors to collect and verify business information from all customers. Please fill out this form at your earliest convenience. We will be unable to fulfill orders without updated business information and documentation.

NOTE: THIS FORM IS FOR EXISTING AV WHOLESALE LLC ACCOUNTS ONLY.

FULL NAME

First name

Last name

BUSINESS INFORMATION

Business Name

Street address

Street Address Line 2 (Suite/Unit Number)

CITY

Zip code

STATE

Country

Business Phone Number

Business E-mail

TAX INFORMATION

Federal EIN Number

Upload Federal EIN Document

Please provide Federal EIN Document. Allowed file types: png, jpg, jpeg, pdf, gif.

State Tax ID / Business License

Please enter your State Tax ID / Business License as it appears on the document

Upload State Tax ID / Business License

Upload State Tax ID / Business License. Allowed file types: png, jpg, jpeg, pdf, gif.

Tobacco License (if applicable in your state)

Upload Tobacco License

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PACT ACT WHOLESALE FORM

FULL NAME

BUSINESS INFORMATION

TAX INFORMATION

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