New Customer Setup

NEW CUSTOMER SETUP FORM


Business Name
This question is required
DBA
Federal Tax ID/TIN
This question is required
Sales Tax ID
This question is required
Street Address
This question is required
City
This question is required
State
This question is required
Zip
This question is required
Ownership
Sole Owner
Partnership
Corporation
LLC
This question is required
Business Phone
This question is required
Mobile Phone
This question is required
Email
This question is required
Website
Type Of Business
Retail
Distributor
Manufacturer
Other
This question is required
Date Established 
This question is required



Authorized Purchasers

Owner/Principal
This question is required
Title
This question is required

Owner/Principal 
(This is if you have someone other than yourself shopping for you)
(This is if you have someone other than yourself shopping for you)
Title
Phone
Email









PACT ACT
IF YOU HAVE NO PLANS OF BUYING TOBACCO PRODUCTS, YOU DO NOT NEED A TOBACCO LICENSE TO SUBMIT FORM.
Upload a Photo of your Business License / Reseller's Permit or Sales and Tax Exemption Certificate. 
Choose a file
This question is required
Upload a Photo of your Tobacco License
(If required by state)

Choose a file
(If required by state)
Upload a photo of your E-CIG Retailer Permit 
Must submit if you need to purchase any E-cigarette devices 
Choose a file
Must submit if you need to purchase any E-cigarette devices 
Upload a photo of your Hemp License (Required if your planning to buy Hemp Products.) 
https://www.dshs.texas.gov/sites/default/files/hemp/Consumable-Hemp-Registration-Guide.pdf
Choose a file
https://www.dshs.texas.gov/sites/default/files/hemp/Consumable-Hemp-Registration-Guide.pdf
Upload a photo of your Drivers License or ID*

Choose a file
This question is required



EXTRA/OPTIONAL

Credit Card Authorization 

If you would like to set up your card info with us before your first order you can do it here. If not we can do it after you submit your first order.

Card Type
Please note that there is a 3% Fee 
MasterCard
VISA
Discover
AMEX
Other
Please note that there is a 3% Fee 
Cardholder Name (as shown on card)
Card Number
CVV
Expiration (mm/yy)
Cardholder Zip Code
I authorize Austin Wholesale Supply to charge my credit card above for agreed-upon purchases. I understand my information will be saved to file for future transactions on my account.
Yes
No
I authorize Austin Wholesale Supply to charge my credit card above for agreed-upon purchases. For my current order only.
Yes
No
Customer Name
/
/
Sign here


Where did you hear about us?
Website
Instagram
Email
Facebook
Word of Mouth
Outdoor Signs
If a sales rep you can put there name in other
Other
Submit