Registration - Bodega

What type of business are you running?

Physical Dispensary

Online Dispensary

Delivery Service

Do you ship across Canada?

Yes

No

How long have you been operating? (years)

Dispensary/Delivery Service Name

URL to your website (if you have one)

Email

Please note, we will be sending a sample package upon account approval; please ensure the correct mailing address is entered.

First Name

Last Name

Street Address

Phone

Address Line 2

City

Province

Postal Code

Username

Password

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Confirm Password

Confirm password