Refer a Retailer

This document should be completed and sent to Hemp Shack once you have discussed with the retailer regarding the potential of carrying Hemp Shack products, and they are interested. It's essential that you have had some form of verbal interaction with them, such as a phone call or a face-to-face conversation.

Company Name *

Contact Name

Street Address *

Address Line 2

City *

State / Territory *

Post Code *

Phone Number *

Email Address *

Referred by (Your Name) *

Have you spoken to this retailer? *

How did you contact your potential retailer? *

Please provide all details of conversations held

What is the lead potential? *

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