NEW STORE SIGNUP Please fill out, and submit, the form below so we can capture your information. We will create a new account for you and email you your login credentials shortly. New Store Sign Up Form Sales RepStore Name*Name* First Last TitleEmail* Mobile PhonePlease add your mobile phone numberDirect PhonePlease add your direct phone numberStore Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Website Type of Store*What type of Store are you (select all that apply)? Adult Shop CBD Store Convenience Store Dispensary Distributor Dive Shop Farmer’s Market Fulfillment Center Gas Station Head Shop Health Food Store Kratom Store / Lounge Medical Facility Online Store Pharmacy Smoke Shop Tobacco Shop Vape Shop Wholesaler 1 – Enter the # of Hemp Toke cartons received2 – Enter the # of Royce cartons received3 – Enter the # of Shaboink cartons received4 – Enter the # of Sherbinskis cartons received5 – Enter the # of Stunna cartons receivedDid they receive an acrylic case? Select All Shaboink Sherbinskis Gelato Stunna Hemp Toke Contact NotesCommentsThis field is for validation purposes and should be left unchanged.