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

Message (optional)

By clicking register, you agree to the Terms & Conditions

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Wholesale Login

Username *

Password *

Remember Me

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*The statements made regarding these products have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease. All information presented here is not meant as a substitute for or alternative to information from healthcare practitioners. Please consult your healthcare professional about potential interactions or other possible complications before using any product.