Retail program form

Retail & Wholesale Program Application

Join our network of premium retailers and wellness partners

Full Name*

Email Address*

Phone Number

Business Contact Position*

Business Website

Do you have a physical store location?*

Yes

Business Address*

Which of these best describes your business/organization?*

How did you hear about us?*

How many locations does your business have?*

Please share your social handles for your business (Instagram, etc.)

Check yes if you'd like to opt-in to receive free marketing materials and product samples for your location