Wholesale Application Apply for your wholesale account 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 SaharaYemenZambiaZimbabweÃ…land 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 SaharaYemenZambiaZimbabweÃ…land Islands Country The address that you want Utoya to ship tooSales Manager(Required)Who helped you? If nobody, select None. Choose a repNONEShannonCodyJohn CarterLauraleeMikeyAmberJohn KerriganDo you want samples?(Required)Please enter sample types you are interested in. If none, enter N/A. Create Your Log-In CredentialsCreate your username and password for logging in.Username(Required) Password(Required) Enter Password Confirm Password Strength indicator 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.Enter SourceGoogle SearchWeb Search (Bing/DuckDuckGo/Yahoo/etc.)Sales Rep Walk-InSales Rep Phone CallEvent or Trade Show ReferralWeb AdvertisementE-MailPostcardYouTubeTwitchFacebookTwitterRedditOther / Can't RememberSpecial Notes/CommentsConsent(Required)AGREEMENT AND ACKNOWLEDGEMENT By signing this document electronically, I hereby acknowledge and agree to the following: Truthfulness and Accuracy: I affirm that the information provided in this form has been filled out completely, accurately, and truthfully, in accordance with Florida Statutes § 817.49, which pertains to false reports. Electronic Signature: I confirm that the electronic signature affixed to this document was drawn by my own hand and serves as my binding agreement to the terms herein, as stipulated under Florida Statutes § 668.50, known as the “Electronic Signature Act of Florida.” Communication Consent: I grant permission to Utoya Group LLC. and its authorized representatives to communicate with me through various channels, including but not limited to phone calls, text messaging (SMS), online live chat, email, electronic messaging through social media platforms, and in-person visits for scheduled events, as per Florida’s guidelines on electronic communications. Liability and Indemnification: As an approved wholesale member making any purchase at Utoya, I agree to indemnify and hold Utoya Group LLC. harmless from and against any claims, liabilities, damages, losses, and expenses arising out of or in any way connected with the products, activities, or any other relations to the products and their consumption. I acknowledge that Utoya Group LLC. does not monitor activities, dealings, or behaviors at the locations where its products are sold and does not condone illegal activity, in line with Florida’s product liability and consumer protection laws. Compliance with Local and State Laws: I acknowledge and agree that I am solely responsible for complying with all applicable local and state laws and regulations pertaining to the purchase, possession, use, and distribution of products from Utoya Group LLC. I understand that failure to comply with such laws and regulations may result in legal consequences for which Utoya Group LLC. will not be held liable. By affixing my electronic signature below, I confirm my understanding and acceptance of the terms and conditions outlined in this agreement. I agree to the privacy policy.SignatureThis 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.CommentsThis field is for validation purposes and should be left unchanged.
