BUSINESS NAME/COMPANY*

BUSINESS LICENSE NO./FEDERAL TAX ID/SELLERS PERMIT/CANNABIS STORE LICENSE NO. OR OTHER (verification will be done by your sales rep once the form is submitted)*

MENTION LICENSE TYPE (BUSINESS LICENSE/FEDERAL TAX ID/SELLERS PERMIT/CANNABIS STORE LICENSE OR OTHER ) *

FIRST NAME*

LAST NAME*

EMAIL ADDRESS*

REGISTERED BUSINESS ADDRESS*

PHONE NO.*

(Your assigned sales rep will reach out to you within no time to confirm the registration)
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