Business DBA Name
*
Business Legal Name
*
Owner's Name
*
First Name
Last Name
State of Incorporation
*
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Website address? (if applicable)
Date Business Started
*
-
Year
-
Month
Day
Date
Business Type
*
Ecommerce Website
Brick and Mortar Retail
Both
Business Structure
*
Corporation
LLC
Sole Proprietor
Partnership
Other
EIN/TIN
*
Monthly Sales Volume
*
$0 New Business
$1,000 to $5,000
$5,000 to $10,000
$10,000 to $25,000
$25,000 to $50,000
$50,000 plus
Average Ticket Amount
*
High Ticket Amount
*
Current Payment Processor
*
List 3rd Part Vendors (Fulfillment, Billing, Customer Service, CRM, etc.)
*
Transactional Breakdown
*
Fullfillment or Delivery Timeframe:
*
0-6 Months
6-12 Months
12+ Months
How are your CBD products used?
*
Ingested: For example, tinctures, pills, oils with droppers.
Topical: For example, skin care, bath and body.
Both
Other
Explanation of Business and Concerns
*
Please verify that you are human
*
Save
Submit
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm