WHOLESALE SIGNUP FORM Please fill out and submit the form below. cDistro will review your information and will manually approve you. Only approved accounts have access to our Wholesale Pricing. Wholesale Sign Up Form Name* First Last Email* Mobile Phone*Please add your mobile phone numberDirect PhonePlease add your direct phone numberCompany NameIf applicable, the name of your company TitleWhat is your title at your company? Type of cDistro Member*What type of cDistro Member are you (select all that apply)? Adult Shop CBD Store Cell Phone Store Convenience Store Dispensary Distributor Dive Shop Event Organizer Farm Farmer’s Market Fulfillment Center Gas Station Gift Shop Head Shop Health Food Store Influencer Investor Kratom Store / Lounge Liquor Store Manufacturer Medical Facility Museum Online Store Pet Store Pharmacy Printer Retailer School School – College Smoke Shop Surf Shop Tobacco Shop Vape Shop Wholesaler Who referred you to cDistro?*Our Wholesale Portal + Marketplace are for members only. Everyone who applies to become a member will be manually approved to ensure confidentiality. To join you must be referred by a member. Are you a Government Agency?*Are you representing a Government Agency? Are you acting in an official capacity or as a finder? I represent a Government Agency I am acting in official capacity of a Government Agency I am a finder working with a Government Agency I am NOT working with a Government Agency When are you ready to make a purchase?*How long until you and/or your group intend on making a purchase? Immediately 1 – 3 Weeks 3 – 5 Weeks 5 – 7 Weeks 7 weeks or more Unsure CAPTCHA Δ
