Onboarding Form

Date*

Dispensary Name*

Legal Business Name (if using a DBA)

Address*

Example: 420 Cannabis St New York, NY 42020

Remittance Address (if different from above)

Example: 420 Cannabis St New York, NY 42020

Primary Contact*

Primary Phone*

Primary Email*

Ordering/Manifest Contact *

Ordering/Manifest Phone *

Ordering/Manifest Email *

Accounts Payable Contact*

Accounts Payable Phone*

Accounts Payable Email*

Marketing Contact*

Marketing Email*

Staff Count*

Website/Online Menu Contact*

Website/Online Menu Phone*

Website/Online Menu Email*

Dispensary Website*

OCM License Number*

OCM License*

WARNING: For use only by persons 21 years of age and older. Keep out of reach of children and pets. If someone accidentally consumes cannabis, contact the Poison Center. Consume responsibly. Cannabis can be addictive. If you or someone you know is struggling with substance use, help is available through the New York State HOPEline at 1-877-846-7369, text 467369, or visit oasas.ny.gov/hopeline.

VETERANS HOLDINGS INC

OCM-PROC-24-000069

34 West Fulton Street

Gloversville, New York 12078

Tel: (518) 444-1200

service@veteranschoicecreations.com

QUESTIONS?

Press: veteranschoice@marinopr.com

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