PACT Act Registration Form

Wholesale Account Application

Please complete the form below to submit your information for a wholesale account application. As part of the recent amendments to the PACT Act, we are required to verify that any entity we ship to is a legitimate business, in compliance with applicable state, county, and municipal laws, and that we have proof of such compliance.

The following documentation is required:

Any license or permit required in your state to legally sell ENDS products. This may include a tobacco license, general business license, sales tax permit, or an OTP license in your state. The document must be current and active.

If you operate multiple locations, we will need documentation for each address to which we will ship.

All businesses are required to submit an FEIN letter or equivalent federal registration certificate.

To obtain an approved wholesale account with GoodOmen USA, you must first create an account on our website and submit this form. Once completed, you may also send an email to info@GOODOMENUSA.com.

First Name *

Primary Contact

Last Name *

Primary Contact

Email *

Phone *

Federal Tax ID *

The FEIN number is located on your SS-4 form. Example: 12-3456789

Please attach a copy of your Federal Tax ID.

Select a file or drag it here

temp-for-0-file2-2_

Example: IRS SS-4 form. Only .jpg, .jpeg, .png, and .pdf formats are accepted.

Message *

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

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