Company Name
*
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
1. What Breeder's Best cultivar(s) did you grow last season?
*
Pink Boost Godess
Blue Skunk
Black Apple Kush
Orange Cream Frost
Oaxacan Wise
Old Toby
Anomaly
2. Total harvest for last season?
*
Lbs.
3. How much harvest sold to date?
*
Lbs.
4. What kinds of products of BB cultivars did you sell?
*
Dried Flower
Fresh Flower
Extracts
Processed Consumable
Pre-Rolls
Other
5. Please attach METRC report(s) verifying answers to questions #2-3.
*
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6. Total revenues from sales of BB cultivars?
*
7. Royalty Owed
*
8. Payment Options
*
Please Select
ACH Debit
Wire Transfer
Mailed Check
Please fill out the form below for ACH Debit Authorization.
*
Please see the form below for our wire instructions, please additionally fill out the form and sign where indicated.
*
Please see the form below for our mailing address, additionally please fill out the form and sign where indicated.
*
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