Retail Application

In order to purchase selected Brothers Broadleaf product for retail shops, fill out the form below and supply requested documents.

After we verify your information (usually within 2-3 business days) you will receive a welcome email with retailer login information. Retailer accounts will not be attached to any personal account you may have and can not use the same email associated with any current open accounts.

If you have issues with the form please Contact Us

Name of Business (DBA) *

Name of Person Responsible for Purchasing

First

Last

Email to be used for the Account *

This email address cannot be already set up with a personal account, if the email is already set up then the personal account will be deleted so that the retailer account can be created.

Contact Phone Number of Purchaser *

Store Phone Number

Business Information

Street Address of Store *

Unit Number

City *

State *AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code

FEIN

Upload the following document(s) in .pdf .png .jpg .doc

If you have issues with the form please Contact Us

If you get an ERROR uploading documents please submit application anyway.
We will contact you by email to request needed documents.

Sales Tax License

Click or drag a file to this area to upload.

Retail Tobacco Sales

Click or drag a file to this area to upload.

Tobacco Products Tax License

Click or drag a file to this area to upload.

Department of Revenue Privilege Tax License

Click or drag a file to this area to upload.

OR enter Local Tobacco Retail License #

Sales & Use Tax Permit

Click or drag a file to this area to upload.

Retail Tobacco Permit

Click or drag a file to this area to upload.

CA Board of Equalization Seller's Permit

Click or drag a file to this area to upload.

California Cigarette and Tobacco Products Retailers OR Distributors License

Click or drag a file to this area to upload.

Sales Tax License

Click or drag a file to this area to upload.

Tobacco Products Retailer License

Click or drag a file to this area to upload.

Sales & Use Tax Permit

Click or drag a file to this area to upload.

Tobacco Retailer License

Click or drag a file to this area to upload.

Annual Resale Certificate for Sales Tax

Click or drag a file to this area to upload.

Department of Business & Professional Regulation: Alcohol Beverages & Tobacco

Click or drag a file to this area to upload.

Certificate of Regulation: Sales & Use Tax

Click or drag a file to this area to upload.

Retail Tobacco License

Click or drag a file to this area to upload.

General Excise Tax

Click or drag a file to this area to upload.

Cigarette and Tobacco Tax License

Click or drag a file to this area to upload.

State Tax Commission Seller's Permit

Click or drag a file to this area to upload.

State Tax Commission Tobacco Tax Permit

Click or drag a file to this area to upload.

Illinois Business Authorization Certificate of Regulation Sales & Use or IL Department of Revenue Certificate of Regulation

Click or drag a file to this area to upload.

Illinois Department of Revenue Tobacco Products Retailer OR Cigarette & Tobacco Products Retailer

Click or drag a file to this area to upload.

Registered Retail Merchant Certificate

Click or drag a file to this area to upload.

Tobacco Sales Certificate

Click or drag a file to this area to upload.

Retail Sales Tax Permit

Click or drag a file to this area to upload.

Iowa Cigarette/Tobacco Retailer

Click or drag a file to this area to upload.

Retailer's Sales Tax Registration Certificate

Click or drag a file to this area to upload.

Sales and Use Permit

Click or drag a file to this area to upload.

(Louisville stores only) Jefferson County Tobacco Retailers Permit

Click or drag a file to this area to upload.

Department of Revenue Resale Certificate

Click or drag a file to this area to upload.

Tobacco Retail Dealer Permit

Click or drag a file to this area to upload.

Resale Certificate

Click or drag a file to this area to upload.

Retail Tobacco License

Click or drag a file to this area to upload.

Sales and Use Tax License

Click or drag a file to this area to upload.

Maryland Tobacconist License OR Other Tobacco Products Retailer

Click or drag a file to this area to upload.

Sales and Use Tax Registration

Click or drag a file to this area to upload.

Retailer License for Sale of Cigars OR Distributor License for Sales of Cigars

Click or drag a file to this area to upload.

Michigan Sales and Use Tax Certificate of Exemption

Click or drag a file to this area to upload.

State of Minnesota Depart of Revenue Sales Tax Number

Cigarette and Tobacco Distributor License

Click or drag a file to this area to upload.

Permit To Engage/Under Sales Tax Law

Click or drag a file to this area to upload.

Tobacco Permit

Click or drag a file to this area to upload.

Retail Sales License

Click or drag a file to this area to upload.

Department of Revenue Annual Tobacco Product License

Click or drag a file to this area to upload.

Master License - Tobacco Product Retailer

Click or drag a file to this area to upload.

Department of Revenue Sales Tax Permit

Click or drag a file to this area to upload.

Department of Revenue Tobacco Products License

Click or drag a file to this area to upload.

Sales Tax Permit

Click or drag a file to this area to upload.

Nevada Tobacco Retail Dealer’s License

Click or drag a file to this area to upload.

No Documents needed at this time (definition of tobacco does not include cigars)

Certificate Of Authority: Sales & Use Tax

Click or drag a file to this area to upload.

Certificate Of Authority: Tobacco and Vapor Products

Click or drag a file to this area to upload.

Tax and Revenue Department Registration Certificate

Click or drag a file to this area to upload.

New Mexico Regulation and Licensing Department Tobacco License

Click or drag a file to this area to upload.

Certificate of Authority: Sales & Use Tax

Click or drag a file to this area to upload.

Certificate of Registration for Cigarette & Tobacco Products: Tobacco Retail Dealer License

Click or drag a file to this area to upload.

Sales and Use Certificate of Registration

Click or drag a file to this area to upload.

Tobacco Products (Other than Cigarettes) License

Click or drag a file to this area to upload.

Sales and Use Tax Permit

Click or drag a file to this area to upload.

Office of Attorney General: Tobacco Products License

Click or drag a file to this area to upload.

Vendors License

Click or drag a file to this area to upload.

Tax Commission Sales Tax Permit

Click or drag a file to this area to upload.

Tax Commission Wholesale Tobacco License

Click or drag a file to this area to upload.

Oregon OR Local Tobacco Products Retail License

Click or drag a file to this area to upload.

Sales Tax License

Click or drag a file to this area to upload.

Tobacco Products License

Click or drag a file to this area to upload.

Department of Revenue Permit To Make Retail Sales

Click or drag a file to this area to upload.

Local Tobacco Retail License (upload if required by your county and/or city)

Click or drag a file to this area to upload.

Department of Revenue Retail License

Click or drag a file to this area to upload.

Department of Revenue License to Sell, Purchase and Distribute Manufactured Tobacco

Click or drag a file to this area to upload.

Sales and Use Tax License Registered to sell Tobacco Products

Click or drag a file to this area to upload.

Certificate of Registration: Sales and Use

Click or drag a file to this area to upload.

Texas Sales and Use Tax Resale Certificate (form 01339)

Click or drag a file to this area to upload.

Tobacco Retailer Permit

Click or drag a file to this area to upload.

Tax Commission Sales Tax License

Click or drag a file to this area to upload.

Tax Commission Cigarette / Tobacco License

Click or drag a file to this area to upload.

Department of Revenue Sales & Use Tax Registration

Click or drag a file to this area to upload.

Vermont Wholesale Cigarette and Tobacco Dealer License

Click or drag a file to this area to upload.

Sales Tax Certificate

Click or drag a file to this area to upload.

Virginia Retail Tobacco License

Click or drag a file to this area to upload.

Master License - Tax Registration

Click or drag a file to this area to upload.

Master License - Tobacco Product Retailer

Click or drag a file to this area to upload.

State Tax Department Business Registration with a Certification for Tobacco

Click or drag a file to this area to upload.

Sales and Use Seller's Permit

Click or drag a file to this area to upload.

Local Tobacco License

Click or drag a file to this area to upload.

Department of Revenue Sales/Use Tax License

Click or drag a file to this area to upload.

Department of Revenue Cigarette/Tobacco Retailer License

Click or drag a file to this area to upload.

Sales Tax Permit

Click or drag a file to this area to upload.

Basic Business License for Cigarette Retail or Wholesale

Click or drag a file to this area to upload.

Sales Tax License

Click or drag a file to this area to upload.

Cigarette and Tobacco License

Click or drag a file to this area to upload.

Submit Application