New Distributor Sign-up Form

All fields required. Please fill out the form below in its entirety. A TzuFuma representative will review and respond to your inquiry promptly.

"TzuFuma Inc." is no longer accepting applications from Distributors that distribute E Cigarette products within the United States. We do however welcome applications from Distributors from within the United States that have distribution outlets outside the United States.


Name of company:
Years in business:
Market Sector:
Contact Person (Officer, Director):
Tax ID Number:
Sales Tax ID Number:
Web site address:
Street Address1:
Street Address 2:
City:
Province:
Postal Code:
Telephone Number:
Fax Number:
Email:
Location where company is domiciled:
What is your current main line of distribution:
Comments:
NOTE: By submitting this form, you herby agree that TzuFuma, Inc. will expedite due diligence on your company.

contact TzuFuma at: ir@tzufuma.com