Store Registration Form

Store Registration

Please enter your personal information below:

* Required fields must be completed

Referral ID:* Referral Name: Full Send Canna

Coupon Code: If you have a coupon code enter it above

Personal Information

Store Name:*

Contact First Name:*

Contact Last Name:*

Phone Number:* Example - 9596768799

SSN / Tax-ID / EIN #:

Birth Date:*Example: mm/dd/yyyy - 05/15/1970

http://www.fullsendcanna.com/

Username:* Your User Name can be between 1 and 20 characters long. Try to use a name that represents you and/or your company name. Please do not use invalid characters like spaces or !@#$%^&*()?.,<>'";:\/{}[].
Enter the unique "user name" in the box above that you want for your Website.
This will be your personal website to use and share. Please write down your website. Example - your "Full Send Canna" website:
If you type "bob" in the box above, your Personal "Full Send Canna" Corporate web address will be: http://www.fullsendcanna.com/bob
All website address names are subject to approval by Full Send Canna

Email Address:*

Please Verify Your Email Address:*

Address

Country:*

Address:*

Suite/Apt:

City:*

State or Province: Other:

Zip:*

Password:* (minimum of 7 characters)

Confirm Password:*

The password you entered above will be used when accessing your backoffice. Please enter your password below twice to make sure it is entered correctly into our system.