Please sign up!

Use the form below to apply to our wholesale program. You must have a related business and valid EIN. No tobacco licenses are required to sell Elixir products.

Name*
First Last
Email*
Company Name*
Company EIN Number*
Phone*
Company Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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Phone
This field is for validation purposes and should be left unchanged.