Wholesale Application

Wholesale

Step 1 of 3

Job Title / Position(Required)

Owner

Purchasing Manager

Temporary staff member

Your Name(Required)

First Last

LINE ID

Your Phone(Required)

Your Email Address(Required)

Enter Email Confirm Email

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Best Time To Call You

When is the best time for us to reach you via telephone?

Business Type(Required)

Retail Dispensary

TTM Clinic

Private Hospital

Licensed Distributor

Other

Registered Company Name(Required)

Thai Tax ID Number (TIN)(Required)

Shipping / Delivery Address(Required)

Controlled herbs must be transported to permitted locations

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country