Reseller Application – Palvape Vape Supplies

WARNING: This product contains tobacco free nicotine. Nicotine is an addictive chemical.

WHOLESALE ONLY! This site can only be ordered by verified reseller customers.

Reseller Application

Wholesale / Distribution Sign up

Name *

First

Last

Email *

Phone

Business Name *

Sellers / Resellers Permit *

Click or drag a file to this area to upload.

* File types: .pdf,.png,.jpg

Business License *

Click or drag a file to this area to upload.

* File types: .pdf,.png,.jpg

Website / URL

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Message *

Checkboxes

I allow my information to be used for marketing campaigns