Wholesale Application (1) Apply for your wholesale account Step 1 of 4 25% Business InformationPlease use the name of the individual responsible for making the purchase for this business. Use any alternative information at checkout in the shipping section.Name(Required) First Last Primary Phone Number(Required)The best way for us to get in touch with the individual who pays the bills.Email(Required) Enter Email Confirm Email Name of Business(Required)The business as it appears on your FEIN or if you are operating as a DBA, provide both (ie: John Smith Inc. DBA Foxy Smoke Shop) EIN/FEIN(Required)Employer Identification Number / Tax ID. This must be able to be looked up and verified. If it is not active, we cannot approve the account. Licenses You Have(Required) Licensed Food Establishment Alcohol License Retail Tobacco or Nicotine Products Dealer Permit (RTPD/RNPD) Licensed Hemp Kitchen Licensed Food Manufacturer Resale License Business License Business Licensing DocumentsUpload your business licenses that are applicable to your store. When inspected, Utoya Group LLC is required to show a record of all we do business with and prove they are in good legal standing. Screenshots are acceptable so long as they are legible. Drop files here or Select files Accepted file types: png, jpg, jpeg, pdf, Max. file size: 256 MB. Type of Business Conducted(Required) Smoke Shop (Glassware, Edibles, Tobacco) Health Food Store Spa Rehabilitation Center / Wellness Treatment Center Doctors Office Alcohol Bar Hookah Lounge Cafe (Coffee, tea, food, drink, etc) Lounge (General) Kiosk Event Vendor eCommerce (Online Sales) Wholesale Distribution Network Manufacturer of Hemp Goods Billing Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country The address that you use for your bank/credit card/debit card.Shipping Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country The address that you want Utoya to ship tooSpecial Shipping RequirementsIf you have a building code or any instructions of special note that would help our package carriers ensure proper delivery. Provide this information here. Your Online PresenceDetail your online profile so we can include you in our networks!Store Website Facebook YouTube Twitch Instagram Username Reddit Username Twitter Username Create Your Log-In CredentialsCreate your username and password for logging in to https://wholesale.utoya.com.Username(Required) Password(Required) Enter Password Confirm Password Strength indicator Thank you for your interest!Below you’re welcome to let us know if you want anything for your store, tell us how you felt about our form, and tell us anything you think we should know, or provide feedback as you please. Finally, sign the form and authorize the submission!How did you learn about Utoya?How did you hear about us? If multiple sources, identify the one that made the best impression for you.Google SearchWeb Search (Bing/DuckDuckGo/Yahoo/etc.)Sales Rep Walk-InSales Rep Phone CallEvent or Trade Show ReferralWeb AdvertisementE-MailPostcardYouTubeTwitchFacebookTwitterRedditOther / Can't RememberName of Sales RepIf applicable, name the sales rep who you spoke with. First Last Do you want promotional materials for your store?Promotional materials include posters, hats, shirts, mugs, and other SWAG that is provided by Utoya Group LLC. Yes, we like promotional materials No, we don’t need them We are unsure at this time How was your experience filling out this form?ExcellentPretty goodNeutralNot so greatTerribleWas the form easy to fill out for you? Special Notes/CommentsSignature Reset signature Signature locked. Reset to sign again This signature authorizes this form as complete, accurate, and true. The signature further certifies that this form does not contain information that belongs to someone else without their express written consent and knowledge of activities and business conducted between themselves and Utoya Group LLC.Consent(Required)I Agree that this form was filled out completely, accurately, and truthfully. My signature was drawn electronically by my own hand to confirm this. I agree to allow communications between myself and Utoya Group LLC. and its authorized representatives, via phone calls, text messaging (SMS), online live chat, email, electronic messaging through social media platforms, and physical visits to locations for scheduled events when applicable. I agree to the privacy policy.EmailThis field is for validation purposes and should be left unchanged.
