Vendor Application – KUSH KLINIC | LOS ANGELES

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Vendor Application

Please apply by filling out the details below.

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Brand Name / Company Name

Name of Brand / Business

@ Social Media Account

Job title

Phone

Email address

Name

First

Last

Product Category*

Upload your Picture or video of product

Upload your Picture or video of product

Maximum size 10MB.

Online Product Menu or Link

Provide the link here. EG: https://www.yourbrandwebsite.com/menu

Description of Product*

Pricing Table

Wholesale Pricing*

Suggested MSRP*

Why should we carry your Brand?*

This field should be left blank

Delivery Hours: Monday-Sunday 10AM-7PM

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Verification Code

Please type the verification code sent to

SUBMIT

Mobile Number

SMS Passcode

Remember Me

Login With SMS Passcode

Resend SMS Passcode(00:20)

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First Name

Mobile Number

Email

State ID/ US Passport Number *

Street Address *

City *

Select fileSelect File

Upload your California State ID / US PASSPORT *

Select fileSelect File

Upload your Medical Recommendation *

State *

ZIP *

Last Name *

Date of Birth *

1.Register Now 2.Get Verified 3.Order

For Assistance signing up, Contact us at
Email: [email protected]
Phone:+13234547010 Member Registration *

California Medical Rec Number *

Resend SMS Passcode (00:20)

Delivery Address

Tell us where you are.

City

City

Zipcode

Zipcode

Delivering to Los Angeles, CA

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Delivery Order Hours: Daily 10:00AM-7:00PM

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Delivery Hours

Monday	10:00 AM — 7:00 PM
Tuesday	10:00 AM — 7:00 PM
Wednesday	10:00 AM — 7:00 PM
Thursday	10:00 AM — 7:00 PM
Friday	10:00 AM — 7:00 PM
Saturday	10:00 AM — 7:00 PM
Sunday	10:00 AM — 7:00 PM

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