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Contoso, Ltd.
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EU Lead Applications
Store Information
Company Name
*
*
Main Contact Name
*
*
*
First Name
Last Name
Phone #
*
Email
*
*
*
Website
*
Contact Phone #
*
Do You Sell Products Online?
Do You Sell Products Online?
No
Do You Sell Products Online?
Yes
How did you hear about us?
*
Trade Show
Direct Mail
Web Search
Social Media
Referral
Brand Referral
Email
Shipping Address Information
Shipping Street 1
*
Shipping Street 2
*
Shipping City
*
Shipping Postal Code
*
Shipping Country/Region
*
Billing Address is the same as Shipping Address
Billing Address Information
Billing Street 1
*
Billing Street 2
*
Billing City
*
Billing Postal Code
*
Billing Country/Region
*
Business Type (Check all that Apply)
Wholesale
Smoke Shop
Distributor
E-Cig / Vapor Store
Bulk-Buy
Cultivator / Extractor
Convenience Store
Cigar / Tobacco Store
CBD / Wellness Store
Dispensary
Online Seller/Marketplace
Other
*
Company Description
Please provide any company details here:
*
Tax Information (Please attach a copy of all applicable licenses)
VAT Registered
VAT Registered
No
VAT Registered
Yes
VAT Registration Number
*
Originating Website (will be hidden)
wholesale.greenlane.com
smokegroove.com
GNLN.ca
davincivaporizer.ca
davincivaporizer.com
davincivaporizers.eu
wholesale.gnln.eu
wholesale.gnln.com
wholesale.gnln.nl
wholesale.gnln.fr
conscious-smart.com
conscious-smart.eu
conscious-smart.nl
conscious-smart.fr
ca.greenlane.com
canada.vapor.com
eycemolds.com
gethyer.com
Gpen.com
Gpen.ca
greenlane.com
haringglass.com
higherstandards.com
marleynaturalshop.com
puffitup.com
smokegroove.com
thefirefly.com
Vapium.com
Vapium.ca
vapor.com
vapesandparts.com
vaporizerdepot.com
vibespapers.com
eu.greenlane.com
I HAVE READ AND AGREE TO TERMS AND CONDITIONS
*
Applicant Full Name
*
Date
*
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