Distributor Application

Distributor: A business that warehouses or sells premium tobacco products or accessories from at least one (1) TPA Associate member to TPA Retailers. Note: Distributors who wish to exhibit at the Annual Convention & International Trade Show must join as an Associate Member.

Required Documentation: Distributors must be sponsored by at least one (1) Associate member as part of the application process. Indicate the sponsoring associate member(s) on your application. TPA will verify prior to approving membership.

Required Documentation: Brokers must be sponsored by at least one (1) Associate member as part of the application process. Indicate the sponsoring associate member(s) on your application. TPA will verify prior to approving membership. (from TPA)

AFTER SUBMITTING YOUR APPLICATION, YOU WILL BE REDIRECTED TO THE PAYMENT PAGE
NO APPLICATIONS WILL BE PROCESSED WITHOUT FULL REMITTANCE.

First Name *

Last Name *

Company

Email *

Phone *

Address *

City *

State *

Postal Code *

Country *

Website *

Which membership are you applying for?

Industry Partners applying for membership should have established relationships with at least 1 current PCA Associate/Manufacturer member. Provide the name(s) of those companies here. If none is available, provide an explanation.

Sponsoring PCA Associate Members (company names)

1.
2.
3.

No Established Relationship Explanation

How many employees work for your company (including yourself)? *

Social Accounts

Facebook
Instagram
Twitter
LinkedIn
YouTube
Google Business Profile

Were you referred by someone?

Referrer Member name

Items to Upload

Please upload the following items. Your application will not be processed until we have all the requested documentation.

• Your State Tobacco Sales License

• State Issued Retail License

• A picture of the interior of your business

• A picture of the exterior of your business

Upload Requested Documents

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from company. Message frequency varies. Message & data rates may apply. Text HELP to (XXX) XXX-XXXX for assistance. You can reply STOP to unsubscribe at any time.

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AFTER SUBMITTING YOUR APPLICATION, YOU WILL BE REDIRECTED TO THE PAYMENT PAGE
NO APPLICATIONS WILL BE PROCESSED WITHOUT FULL REMITTANCE.