Vendor Registration Form Vendor Registration Form Please fill out the form below to apply for a wholesale account. Please Note: Accounts are not automatically approved. We will review your application details and ensure as prompt a response as possible given the volume of current applications. Please allow for at least 24 hours.Contact DetailsName* First Last Email* Phone*How would you like to be contacted?* Email Phone No Preference Dispensary DetailsDispensary Name*Dispensary Phone NumberDispensary TypeIs your dispensary a retail storefront or an online dispensary? Online Storefront Photo of your Dispensary*Please send photos of your dispensary and prove that this location matches their shipping address. Website*Please provide a link to your website below: How did you hear about Twisted Extracts?Our existing customers are requesting Twisted Extract productsFacebookInstagramGoogle searchBilling AddressAddress* Street Address Address Line 2 City Please SelectAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code AccountUsername*Password* Enter Password Confirm Password Strength indicator CommentsThis field is for validation purposes and should be left unchanged.