DISTRIBUTOR APPLICATION

First Name

Last Name

Title

Email Address

Phone Number

Skype

Organization Name

Organization Website

Address of Corporate Headquarters

Address 2

City

State

Country

How did you find us?

Who are you currently sourcing your hemp products from?

Do you have a store front?

Yes

How many direct sales representatives does your company employ?

We are interested in white labeling products

Yes, send me more information

No Thank You

Annual Revenue

Please describe your company organization

Which products are you interested in distributing?

What products does your organization currently distribute and/or plan to manufacture?

What is the import process in your country (if outside USA)?

How are you currently marketing your products/organization?

Would you want to sell our products regionally, nationally or Internationally? Which countries / states / districts / areas / cities are you able to distribute to?