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Contoso, Ltd.
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Business Type
Smoke Shop
Cigar / Tobacco Store
Convenience Store
CBD / Wellness Store
Dispensary
Cultivator / Extractor
Online Seller/Marketplace
Tax Information
FEIN Federal Tax #
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Provincial/State Retail Sales Tax Id
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Provincial/State Retail Sale Tax Expiration Date
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Tobacco License Information
Do you have a Tobacco License?
Tobacco Tax License Id
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Tobacco License Expiration Date
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Vape License Information
Do you have a Vape License?
Vape License Id
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Vape License Expiration Date
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Hemp License Information
Do you have a Hemp License?
Do you have a Hemp License?
No
Do you have a Hemp License?
Yes
Hemp License Id
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Hemp License Expiration Date
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CBD License Information
Do you have a CBD License?
Do you have a CBD License?
No
Do you have a CBD License?
Yes
CBD License Id
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CBD License Expiration Date
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Dispensary License Information
Do you have a Dispensary License?
Dispensary License Id
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Dispensary License Expiration Date
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Cultivator License Information
Do you have a Cultivators License?
Cultivator License Id
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Cultivator License Expiration Date
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Extractor License Information
Do you have a Extractors License?
Extractor License Id
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Extractor License Expiration Date
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First Nations/Native American License Information
Do you have First Nations/Native American Tax?
First Nations/Native American Tax Id
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First Nations/Native American Tax Expiration Date
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PROPRIETOR/OFFICER INFORMATION
Proprieter/Officer Legal Name
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Proprieter/Officer Position
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TERMS AND CONDITIONS
I have read and agree to the Terms and Conditions
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Signed By (Applicant Name)
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