New Account Application

Effective 4/1/2021 – all new customers are REQUIRED to pre-pay for orders, either by Credit Card or Check, for a period of no less than 6 months until positive credit is established with Sutliff. Exceptions to this policy can only be approved by Sutliff Management.

Billing Information

Company Name(Required)

DBA(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Shipping Information (If Different)

Company Name(Required)

DBA(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Contact Information

Owner(Required)

Email(Required)

Buyer(Required)

Email(Required)

Accounting(Required)

Email(Required)

Tobacco License Information

License Number(Required)

Expiration Date(Required)

A copy of the license must be included.

License / Permit

Please fax or email a copy of required license to: 804-231-5112 or [email protected].

License Number (Tax License and/or State Tobacco Sellers Permit)(Required)

Business References

Company Name

Contact Person

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Fax

Company Name

Contact Person

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Fax

Company Name

Contact Person

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Fax

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

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