Name (required)

Job Title (required)

Email (required)

Telephone (required)

Business Name (required)

State (required)

Please list one of your license numbers (Medical or Retail)

Are you a Retailer, Cultivator, or Both?

RetailerCultivatorBoth

Do you currently accept debit cards?

YesNo

How many retail locations?

Do you pre-package your flower?
YesNo

Do you currently use a seed-to-sale platform?

Is there anything else you'd like to add?