This is an application for a wholesale account at Empire Imports, LLC. After you submit your application, your documents will be verified before your account is activated. No personal or customer accounts will be approved.
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State * Select an option…AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)
Username *
Email address *
Password *
First name *
Last name *
Company *
Website
Telephone *
Cell Phone
Business Type * Choose one Distributor Smokeshop Vape Shop Convient Store Gas Station Retail Store or Market Other
How did you hear about us? * Choose oneASD Market Week 2025 CHAMPS LAS Vegas 2025 TPE Las Vegas 2025 -- Sales Reps -- Daniel Martinez Eddie Vartanian Edgar Palomino Edwin Rubio Richard Escalante Shawn Berry Joey King Benjamin Ramalho Patrick Roy ---------------- Email Blast Google Referral Tradeshow Postcard Phone Call In-Person Visit Other
Address 1 *
Address 2
City *
Postcode *
Billing Email
My shipping is the same as the billing. Check this if your shipping address is the same as your billing address.
Shipping Email
EIN Number * Enter your EIN number. If you do not have one, you can obtain one from the IRS. If you do not have an EIN, you may submit your Social Security # and a W-9.
Please upload your EIN letter from the IRS (or a W-9 if using your social security number) in a .pdf or .jpg or .png format.*
Business License Number * Enter your Business License number.
Please upload your business license if you have one, in a .pdf or .jpg or .png format.*
State Seller's Permit Number * This is called a Retail Tax ID in some states.
Please upload your seller's permit/retail tax ID in a .pdf or .jpg or .png format.*
Tobacco License Number *
Please upload your tobacco license in a .pdf or .jpg or .png format.*
Tobacco License Expiration * The expiration date must match the uploaded license.
Tobacco License Type * Choose one Retail Wholesale Distributor Manufacturer
What is 6 + 6? *
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