Fortuna Enterprises, LLC: Wholesale Account Form

Wholesale Trade Application

Please complete your business details and a member of our Customer Success Team will be in touch with you shortly.
Name of Business *
Shipping Information
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Please enter a valid phone number.
Online Account Information

Please provide your preferred information to associate with your online store account.
Preferred Email for Account *
A temporary password will be emailed to you upon account approval.
Please upload your state Exemption Certificate *
Drop files here to upload
Cancelof
Cancel of
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Wholesale Trade Application