Dispensary Registration

Dispensary Name(Required)

Legal Business Name(Required)

OCM License(Required)

Location Address(Required)

Billing Address (If Different)

Tax ID/EIN# (Include W-9)

Resale Certificate (NY form ST-120)

Upload License and Forms

Drop files here or

Accepted file types: jpg, webp, png, pdf, Max. file size: 20 MB, Max. files: 5.

First Name(Required)

Last Name(Required)

Phone(Required)

First Name(Required)

Last Name(Required)

Phone(Required)

First Name(Required)

Last Name(Required)

Phone(Required)

Intake Days & Times(Required)

Delivery Instructions(Required)