Corporate Name

DBA (If Any)

Sales Team
I do not have a sales repAl EzzreAngelo CommitoCharles MohrChris LewisDan ElyFelicia CiaccoGraham MontgomeryHeshy DunayerJenny DavisJoe ArazzoKevin GottliebMichael BaxterNikki CoscinoPamela CommitoPierson BoyerRichard SteinhartRon CottingSara VaughnStephen CuevasSteve HerronTom ScamardoWilma Cuevas

Billing Information

Shipping Information

Account Information

Do you sell from a retail space which is a self-contained or physically separate business space?
YesNo

Does your account post a visible sign, have regular business hours, and its own staff and cash register?
YesNo

Is your store attached to or part of a residence?
YesNo

Does your account derive a majority of gross revenues from the sale of natural, nutritional products and consumer products?
YesNo

Will your account sell our products on the internet?
YesNo

Does your account operate any of the following in which our products will be sold?
*Click yes for dropdown optionsYesNo

Does your account operate as one of the following?
*Click yes for dropdown options
YesNo

Is your account a previously existing store under new ownership?
YesNo

Payment Options

We accept payment by credit card, cashier’s check, or company check. Additionally, terms are available and may be established by requesting, completing and submitting a Credit Application form.

Account Signature

Disclaimer: CBD Unlimited, Inc reserves the right, in its sole discretion, to determine which customers or potential customers may purchase its products, and what selection or combination of products, if any, are available to each approved customer. CBD Unlimited, Inc also reserves the right, in its sole discretion, to sell to any party, to refuse to sell to any party, or to cease selling to any party.

By Checking this box I certify that I have read and accept the above Disclaimer and that the information provided in the sections above is complete and accurate.
I accept