Business Owner Name

First Name*

Last Name*

Personal Cell

Business Phone Number*

Business Info

Legal Business Name*

The name registered with the CRA

Operating Name*

The name used by the company to do business.

Business Number*

The 9-digit number the CRA assigns to businesses and other organizations for tax-related purposes.

Types of Business*

Shipping Address

Address Line 1*

Is Your Billing Address the same as your Shipping Address?

Billing Address

Address Line 1 *

Business License

Business License / Tax License*

Please upload a scan or copy of your government registered Business and/or Tax License. Pdf or image file, maximum size 10MB.

Specialty Store License

Please upload a scan or copy of your government registered Speciality Vape License. Pdf or image file, maximum size 10MB.

Other Information

Are You Tax Exempt*

Yes

Native Status Card (Front)

Please upload a scan or copy of your government registered native status card

Native Status Card (Back)

Please upload a scan or copy of your government registered native status card

How did you hear about us

Your expected average monthly spent

Authorization

Click here to agree with our Terms and Condition

Signature of Business Owner / Authorized Representative

First Name*

Last Name*

Date and Time Signed*

Waterpipes & Rigs

Hand Pipes

Attachments & Accessories

Owner Information

Business Owner Name

Business Info

Types of Business*

Shipping Address

Billing Address

Business License

Other Information

Authorization

Signature of Business Owner / Authorized Representative

EXCLUSIVE DISTRIBUTORS

quicklinks

help desk

Waterpipes & Rigs

Hand Pipes

Attachments & Accessories

Apparel & More

Lifestyle

Odour Control

Clean & Store

Dispensary Supplies

Owner Information

Business Owner Name

Business Info

Types of Business*

Shipping Address

Billing Address

Business License

Other Information

Authorization

Signature of Business Owner / Authorized Representative