Form

First Name*

Last Name*

Legal Business Name*

"Doing Business As" (DBA) Name

Email*

Phone*

Business Address*

City*

State*

Zip Code*

Which HVCU Branch is Most Convenient for You?*

Preferred Contact Method*

Phone

Email

Best Time of Day to Reach You*

Cannabis License Type*

Please select all that apply.

Adult-Use Cultivator

Adult-Use Conditional Cultivator

Adult-Use Nursery

Adult-Use Processor

Adult-Use Distributor

Adult-Use Cooperative

Adult-Use Microbusiness

Adult-Use Retail Dispensary

Adult-Use On-site Consumption

Adult-Use Delivery

Registered Organization Adult-Use Cultivator, Processor, Distributor, Retail Dispensary

Registered Organization Adult-Use Cultivator, Processor, Distributor

Comments/Questions

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