Indica Dreams Retailer Application Form Please enable JavaScript in your browser to complete this form.First Name *Last Name *Email *Phone Number *Include country code if outside of USACompany NameStreet AddressCity/TownStateZip CodeCompany Website AddressTax ID/Resellers Certificate #Number of LocationsComment or Message *Indica Dreams™ Wholesale Agreement Verification *By checking this box I agree that I have read and understand all terms and conditions noted within the Indica Dreams Wholesale Agreement located HERE. Please download, sign, and email a copy to hello@indicadreams.com Submit