Form VB-R
Division use only – Date Stamp
State of New Jersey
Division of Taxation
PO Box 187
Trenton, NJ 08695-0187
Application for Vapor Business License
In compliance with Chapter 39, P.L. 1990, as amended, beginning November 1, 2019, New Jersey defines any business that
sells container e-liquid and has more than 50 percent of its retail sales derived from electronic smoking devices, related accesso-
ries, and liquid nicotine as a Vapor Business and requires that the business obtain a license.
The license is effective for the fiscal year April 1 until March 31 and will need to be renewed each year by March 1.
Vapor businesses are required to obtain a separate license for each place of business, whether established or temporary, from
which container e-liquid is sold or intended to be sold. Complete a separate application for each location.
Include a payment of $50 with this application. Initial Application Renewal Application
Section 1 – Business Information
Federal ID Number
New Jersey Corporation Number
Business Name
Website Address
Trade Name
Phone Number
Fax Number
Physical Address
Mailing Address
Alternate Address (bookkeeper, accountant, etc., that we can contact regarding reporting and payments)
Hours of Operation
Mon.
Tues. Wed. Thur. Fri. Sat. Sun.
Be advised that your business, including a business that operates from a personal residence, is subject to inspection by New
Jersey Division of Taxation employees. This includes sworn law enforcement personnel.
If you wish to have an attorney, accountant, or other individual act on your behalf and have access to your tax information, you
must supply us with an Appointment of Taxpayer Representative form (Form M-5008-R).
Registration Contact Title Phone Number Email Address
Tax Reporting Contact Title Phone Number Email Address
Retail Site Manager Title Phone Number Email Address
Individual Completing This Form Title Phone Number Email Address
Section 3 – Prior Owner Information
Complete only if you are purchasing an existing business.
Former Business Name Former Trade Name Former Phone Number
Former Business Address City, State, ZIP Code Date Ownership Transferred
Former Business Mailing Address City, State, ZIP Code Date Former Business Ended
Section 4 – Type of Ownership
Sole Proprietorship (may include Partnership Limited Partnership
spouse)
Government Entity Trust
Limited Liability Partnership
Out-of-State Corporation Other (specify)
New Jersey Corporation
State:
Date of Incorporation:
Date Registered in New Jersey:
Section 5 – Owner Information
Provide information for a sole proprietor, partners, or principal officers of corporations or limited liability companies (attach rider if necessary).
Name (Last, First, M) Title Social Security Number
Home Address Home Phone Number Cell Phone Number
Name (Last, First, M)
Title
Social Security Number
Home Address Home Phone Number Cell Phone Number
Name (Last, First, M)
Title
Social Security Number
Home Address Home Phone Number Cell Phone Number
Name (Last, First, M)
Title
Social Security Number
Home Address Home Phone Number Cell Phone Number
Section 6 – Relationships With Other Organizations
Provide information for any owner, officer, or employee who operates, manages, or reports for another company that is required to be regis-
tered with New Jersey.
Individual’s Name
Title
Date of Hire
Social Security Number
Individual’s Home Address
City, State, ZIP Code
Name of Affiliated Business
Affiliated Business FID
Title
Effective Date of Title
Address of Affiliated Business
City, State, ZIP Code
Individual’s Name
Title With Applicant
Date Joining Applicant
Social Security Number
Individual’s Home Address
City, State, ZIP Code
Name of Business With Which Affiliation Exists
Affiliated Business FID
Title
Effective Date of Title
Address of Business With Which Affiliation Exists
City, State, ZIP Code
Section 7 – Types of Products
Check each type of product you will be selling in New Jersey.
Cigar Little Cigar Pipe Tobacco
Cigarillo Electronic Cigarette Single-Dose Smokeless Tobacco
Dry Snuff Moist Snuff Smoking Tobacco
Container E-Liquid Liquid Nicotine RYO
Other Tobacco Products – List Products:
Section 8 – Business Activity - Vendors
Provide the name and address of your container e-liquid vendor(s) (attach rider if necessary).
You must notify the Division within 30 days of any changes made to this application after it is submitted, or after a license has
been issued. If you do not notify us, we may reject, suspend, or revoke your license. We may also reject or revoke your license if
you make any misrepresentations in this application.
If your business purchases untaxed tobacco and vapor products other than container e-liquid, you must also complete a
Tobacco and Vapor Products Registration form (Form TPT-R).
Section 9 – Authorizing Signature
I am aware that the information contained in this application is subject to reporting to and auditing by the Division of Taxation of
the New Jersey Department of the Treasury.
Under penalty of perjury, my signature affirms all of the following:
• I certify that my business sells container e-liquid and that more than 50 percent of the business retail sales are derived
from electronic smoking devices, related accessories, and liquid nicotine.
• The information provided in this application, including all attachments, is accurate and complete to the best of my
knowledge.
We will deny this application if any section is inaccurate or incomplete.
Signature Title Printed Name Date Signed
I certify on behalf of the applicant, and under penalty of perjury, that the information contained in this application is true and
correct to the best of my knowledge and belief.
Sworn to before me on this day of , 20 , at [Name of City, State].
Notary Public
Form VB-R Instructions
We will deny this application if any section is inaccurate or incomplete.
Section 1: Business Information
You must enter your federal identification number.
Business name. Your company’s name as it appears on the
business registration.
Trade name. The name by which your company does busi-
ness and is known in the industry.
Physical address. Your company’s location for operations
in New Jersey. If there are no New Jersey locations, enter
your company’s primary business location.
Mailing address. The address we can use to contact your
company regarding general inquires.
Alternate address. The address we can use to contact your
company regarding reporting and payments.
Section 2: Contact Information
Registration Contact. The individual who can answer
questions regarding this application. If this individual is not
an employee or owner of the company, a completed Form
M-5008-R must accompany this application.
Tax Reporting Contact. The individual who can answer
questions regarding the filing of reports and issuance of
payments. If this individual is not an employee or owner of
the company, a completed Form M-5008-R must accompany
this application.
Section 3: Prior Owner Information
This section is for individuals or companies that purchase
an existing business. If you did not purchase an existing
business, enter N/A in the Former Business Name section
and leave all other spaces blank.
Section 4: Type of Ownership
Check only the box that applies.
New Jersey Corporation. You must provide the date of
incorporation.
Out-of-State Corporation. You must provide the state of
incorporation and the date registered in New Jersey.
Other. You must give the type of ownership.
Section 5: Owner Information
Sole Proprietor. Enter the requested information for the
owner of this business.
Partnership. Enter the requested information for all the
partners in this business. If you need additional space, write
“see rider attached” and provide the information on a sepa-
rate sheet.
Corporations or LLCs. Enter the requested information
for all of the principal officers. If you need additional space,
write “see rider attached” and provide the information on a
separate sheet.
Section 6: Relationships With Other
Organizations
Provide information for any owner, officer, or employee who
operates, manages, or reports for another company that is
required to be registered with New Jersey.
Section 7: Types of Products
Check each type of product you will handle in New Jer-
sey. For Other Tobacco Products, you must list each other
product.
Section 8: Business Activity – Vendors
Provide the name and address of your container e-liquid
vendor(s) (attach rider if necessary).
Section 9: Authorizing Signature
Only an individual listed in Section 5 of this application may
sign this application. This application cannot be processed
without an appropriate signature and notary. We will not
process this application without a notarized signature.
Complete all appropriate sections and mail this application to:
New Jersey Division of Taxation
PO Box 187
Trenton, NJ 08695-0187
Enclose the $50 license fee with this application.
Make check or money order payable to: State of New Jersey – Division of Taxation.
We will not process this application if you do not include the $50 fee.