Registration

Please provide a little information about yourself and your business. We’ll get back to you promptly once we’ve verified you as a cannabis reseller.

Dispensary/Delivery Registration (to be filled out by dispensary owners)
ONLY DISPENSARY/DELIVERY SERVICE OWNERS MAY FILL OUT THIS FORM
What type of business are you running?*
- Physical Dispensary
- Online Dispensary
- Delivery Service
Express Approval (enter code if you were provided one)

Provide the code given for express approval.
Referral

Did someone refer you to Greenhouse?
Dispensary/Delivery Service Name*

Provide the name of your medical dispensary/delivery service for which you are applying for membership approval.
Dispensary Address*

Provide the address of your medical dispensary for which you are applying for membership approval.
URL to Your Website (if you have one)
2. Personal Information
Name*
First Last
Email*
Phone*
Address*
Street Address Address Line 2 City Province Postal Code
4. Account
Username*
Password*
Enter Password Confirm Password

Strength indicator
Do you agree to the above terms & conditions?*
- Yes, I declare the above is factual, I agree to terms and conditions and I acknowledge the potential side effects as outlined.
Signature*

Please type your first and last name. This is considered to be an electronic signature. You must agree to the terms above, as well as complete this signature to be eligible for membership.
Comments
This field is for validation purposes and should be left unchanged.

Dispensary/Delivery Registration (to be filled out by dispensary owners)