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19th Ave New York, NY 95822, USA

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    Become a Retailer

    Wholesale Account Application

    Interested in carrying our products? Fill out the application below to apply for a retail partner account. Our team will review your submission and verify your license.

    Approval time: 1–3 business days

    1. Store Information

    Retail Store Name

    Doing Business As (DBA)

    WA Cannabis Retail License Number

    License Expiration Date

    2. Store Location

    Store Address

    City

    ZIP Code

    3. Primary Contact

    Full Name

    Position / Title

    Email Address

    Phone Number

    4. Buyer Information

    Skip if same as primary contact

    Buyer Name

    Buyer Email

    Buyer Phone

    5. Business Details

    Years in Business

    6. Product Interest

    Select all that apply

    7. Store Branding

    Optional – helps us feature your store in promotions and partner listings

    Upload Store Logo

    Store Tagline / Slogan

    8. Store Website & Social Media

    Optional – helps us promote your store

    Store Website

    Instagram

    Facebook

    Other Social Media

    9. Marketing & Promotion Consent

    10. Compliance Confirmation

    11. Retailer Agreement

    Authorized Representative Name

    Title / Position

    Date