CPT Dispensary Form

CPT Dispensary Form

Dispensary Name *

Owner Name *

First

Last

Owner Contact Email *

Owner Phone Number *

Dispensary Type *

• Medical
• Recreational
• Both

Percentage Ownership *

• Over 50%
• Under 50%

How Many Locations? *

How Many Employees? *

Do you accept Debit Card payments? *YesNoATMOther

WebsiteYesNoWeedmapsOther

Main Parking Lot Sq Footage? *

Main Waiting Room Sq Footage? *

Security on Premises?

• Yes
• No

Incentives/Discounts

• Point System
• Membership
• Random Offers

Submit