Owner Information Business Owner Name First Name Last Name Personal Cell Business Phone Number Your Email Business Information Legal Business Name Operating Name Business Phone Number No. of StoresChoose...12345678910+ Types of Business Convenience StoreSmoke ShopCigar StoreHeadshopNovelty And GiftAdult StoreSpecialy Vape StoreOther(s)Hybrid Vape StoreGas StationSub-DistributorDistributorE-commerceCannabis StoreLicense Producer Shipping Address Address Line 1 Address Line 2 State/ProvinceChoose...AlbertaBritish ColoumbiaManitobaNew BurnswickNew Foundland and LabradorNova ScotiaNorthwest TerritoriesNunavutNova Scotia (CA)OntarioPrince Edward IslandQuebecSaskatchewanYukon City Zip CountryCanadaOthers Business License Business License / Tax License Specialty Store License Other Information Are You Tax ExemptYesNo Native Status Card (Front) Native Status Card (Back) Authorization Click here to agree with our Terms and Conditions Signature of Business Owner / Authorized Representative First Name Last Name How did you hear about usChoose...NewsletterMagzineInstagramFacebookTradeshowWebsiteAdvertisementYoutubeWord of MouthSearch EngineCustomer Request Your expected average monthly spentChoose...$250-$1500$1501-$3000$3001-$5000$5001-$10000$10000+ Owner Information Business Owner Name First Name Last Name Personal Cell Business Phone Number Your Email Business Information Legal Business Name Operating Name Business Phone Number No. of StoresChoose...12345678910+ Types of Business Convenience StoreSmoke ShopCigar StoreHeadshopNovelty And GiftAdult StoreSpecialy Vape StoreOther(s)Hybrid Vape StoreGas StationSub-DistributorDistributorE-commerceCannabis StoreLicense Producer Shipping Address Address Line 1 Address Line 2 State/ProvinceChoose...AlbertaBritish ColoumbiaManitobaNew BurnswickNew Foundland and LabradorNova ScotiaNorthwest TerritoriesNunavutNova Scotia (CA)OntarioPrince Edward IslandQuebecSaskatchewanYukon City Zip CountryCanadaOthers Business License Business License / Tax License Specialty Store License Other Information Are You Tax ExemptYesNo Native Status Card (Front) Native Status Card (Back) Authorization Click here to agree with our Terms and Conditions Signature of Business Owner / Authorized Representative First Name Last Name How did you hear about usChoose...NewsletterMagzineInstagramFacebookTradeshowWebsiteAdvertisementYoutubeWord of MouthSearch EngineCustomer Request Your expected average monthly spentChoose...$250-$1500$1501-$3000$3001-$5000$5001-$10000$10000+
