Wholesale Registration Page - Chronic Relief Apothecary

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Wholesale Application Form

Please fill out and submit this form.

Upon completion, you will receive an email with your username and login. Log back into the site using this page or the link in the email, then read and sign the wholesale agreements. Once we have read and reviewed your completed application, we will upgrade your account.

Please Leave This Empty:

First Name *

Last Name *

Company Name *

EIN *

Phone *

Email *

Website

Type(s) of Business *InternetBrick and MortarWholesale

Country *

Address 1 *

Address Line 2 (optional)

City *

State *

Postcode *

Preferred Payment *CheckOnline Invoice (Payment through Square)

I am interested in selling *Light Up Hemp Smokable FlowerUNDOOSYLK LubricantChylobinoid CreamChylobinoid CapsulesCBD SuppositoriesCBD Tincture

Do you have a person Sales Representative? *

Message (optional)

By clicking register, you agree to the Terms & Conditions

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Wholesale Login

Username *

Password *

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