Account Application

Business Information

Please provide some basic information about your business.

Legal Business Name *

DBA

Phone

Company E-mail *

Tax ID / EIN

Website

Contact Information

Please provide information so we can get in touch.

First Name *

Last Name *

Contact E-mail

Billing Address *

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Country *

W-9 Form

Select File(s)

Nature of Business

Please answer the following questions regarding the nature of your business.

Business Type *

Are you a vendor? *

Yes No Do you want to sell products through Highlanders Distribution?

Do you have a license to purchase regulated wholesale products? *

Yes No

BCC/CDPH License Number? *

License Expiration Date *

License Type? *

Medicinal Recreational Both

Do you work with bulk cannabis product or raw materials? *

Yes No

Is your company based in California? *

Yes No

Valid State License

Select File(s)

Valid Local License

Select File(s)

Valid Sellers Permit

Select File(s)

Valid ID for Business Owner

Select File(s)

Name on ID must match the business license.

Additional Information

Please let us know how you heard about us so we can properly tag your account.

How did you hear about us? *

Highlanders Distribution Representative Social Media Web Search (Google, Bing, etc.) E-mail Word of Mouth Other

Business Information

Contact Information

Nature of Business

Additional Information

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