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Agricova Dealer Application

Tell us about your business, your facility and the products you plan to carry. Our dealer desk reviews every application within two business days and follows up with tiered pricing and freight options.

FORM AGR-FM-101REV 2026-09ONLINE · PRINTABLE
Application received. Our dealer desk will contact you within two business days.
01

Business profile

Who you are and how you operate
Business type *
Cannabis or horticulture license that covers resale activity.
02

Contacts & addresses

Where we send approvals, quotes and freight
Freight quotes are based on this address and dock access below.
03

Facility & logistics

How freight reaches your door
Loading dock at delivery address *
Forklift available on site
Drop-ship to end customers
Delivery address is residential
04

Commercial details

What you plan to carry and how you buy
Products you plan to carry *
Preferred payment terms
05

Authorization

Signature and consent

By signing below, I confirm the information provided is accurate and I am authorized to submit this application on behalf of the company named above. Submission does not create a binding supply agreement; dealer terms are issued upon approval.

For Agricova internal use only
Dealer account no.
Approved credit terms
Approved by
All fields marked * are required. Attach license & resale documents by email after submitting.