Registration - Bodega Distro

Registration Form

What type of business are you running?

Physical Dispensary

Online Dispensary

Delivery Service

Do you ship across Canada?

Yes

How long have you been operating? (years)

Dispensary/Delivery Service Name

URL to your website (if you have one)

Please note, we will be sending a sample package upon account approval; please ensure the correct mailing address is entered.

First Name

Last Name

Street Address

Phone

Address Line 2

City

Province

Postal Code

Username

Password

Create your password

If you are human, leave this field blank.

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