CannaBIZ Collects | Bulk Claim Submission

Bulk Claim Submission
Please make sure you have filled out our CannaBIZ Collects fee agreement so we can process and work on your claims. If you do not have our fee agreement, please visit www.cannabizcollects.com/inquiries to request from our team. Thanks!
Your Legal Business Name*
Kindly ensure that if you are submitting accounts for multiple entities or different locations with distinct accounting requirements, you submit a separate form for each entity or location.
Date*

MonthDayYear
Date
Name*

First NameLast Name
Title/ Position*
Email*
Please be aware that we can only utilize a single primary contact email address. In case there are multiple emails to be cc'ed, please include a catch-all email, such as ar@company.com.
Were you referred to CannaBIZ Collects?
Please note company name or individual who referred you to work with CannaBIZ Collects
Direct Phone Number*
Office Phone Number*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Company's Billing/ AP Contact Email
example@example.com
What Industry are you in? (Best fit to your business)*

Full Service MJ ProducerCultivationEdible / ExtractsTesting LabCannabis Distribution / WholesalePackagingGrow SupplyCBD / HempVape (Nicotine)Advertiser / Publication / MediaEquipment (Grow, Extract, Lighting, Etc)Consulting / StaffingOther
Do you authorize: a) Cannabiz to act as your agent to manage the claims you are submitting and agree that claims cannot be reversed once they are submitted. b) Any accounts that were actually paid prior to placement will be subject to a flat $500/claim finder's fee. c) Cannabiz retains the authority to disclose pertinent claim information to third parties, encompassing credit bureaus and credit agencies, including any prior claims previously submitted by the Client. Cannabiz commits to ensuring the anonymization of Client data, safeguarding the Client's identity remains confidential and unidentifiable as the primary source of said data*

Yes
Bulk Claim Spreadsheet Upload (all claims must be submitted in USD)*

File types: xls, xlsx
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Accompanying Documentation (I.e. Invoices, contracts, email/text communication etc). Please keep files organized by naming either each folder or file the name of the debtor company submitted from each row of the Bulk Claim Spreadsheet.*

File types: pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif
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How user-friendly overall was this submission process?*

1

2

3

4

5

1 is Worst, 5 is Best
Should be Empty: