Wholesale Application Wholesale Application Name * First Last * Last Address * Line 2 City City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY State Zip/Postal Zip/Postal Phone * Email * Company Name * Company Website * Business Type * Distributor Online CBD retailer Medical office Health food or grocery store Retail store Restaurant Specialty store Other Business Type What is your role in your business? * Owner/CEO Management Buyer Sales representative Other What is your role in your business? Years in business * Less than 1 year 1 to 3 years More than 3 years Other Years in business Have you purchased CBD products before? * Yes No How did you hear about Core Roots? * Word of mouth Internet search Social media Trade show or event Other How did you hear about Core Roots? Upload Resale Certificate * Drop a file here or click to upload Choose File Maximum upload size: 33.55MB By applying to the Core Roots online wholesale program, I certify that my business is based in the United States and operates in a jurisdiction where industrial hemp-derived CBD products are legal to possess and sell. * I agree reCAPTCHA Reason Submit If you are human, leave this field blank.