Hemp Chews Retailer Request Form

If you are an e-commerce or home business, you will not be approved for wholesale partnership. All other retail business types are welcome to submit a request form for a wholesale account.

Retailer Application: Please allow up to 14 business days for all retail applications to be processed.

First Name *

Last Name *

Company Name *

Federal EIN *

Phone *

Email *

Country (optional)

Address 1 (optional)

City (optional)

State (optional)

Postcode (optional)

Website (optional)

Industry (optional)

Do you intend to sell products online? *

Do you have a physical brick and mortar store that you intend to sell products in? *

Are you part of a medical or therapeutic practice? *

Are you an online retailer *

How did you hear about us? *

Username *

Password

Confirm password