Client Intake Form

Welcome to Botanic Biosciences! We are thrilled that you have chosen to partner with us. To get started, please take a moment to complete our client intake form below. This helps us understand your unique needs and tailor our services to support your goals. Your information is secure, and filling out the form is the first step toward unlocking a personalized experience with us!

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- Step 1 of 3

Contact and Business Information

Who is your Brand Manager? *

Enter the full name and/or user ID of your Brand Manager. If you need a Brand Manager, type 'I need a Brand Manager'.

Name *

First

Last

Company Name

Tax ID Number

Enter your companies EIN Number

Licensing, Sales Timeline

Email *

Confirm Email

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Website / URL

Type of Business

Manufacturer
Retail Storefront
Retail Storefront Dispensary
Online Retail
Online Retail Dispensary
Online Marketplace
Other

If you are a storefront, how many locations do you have

What is your annual revenue?

How did you hear about us?

Word of Mouth / Referral
Trade Show
Advertisement
Search Engine (Google, Bing, Yahoo)
Social Media (Facebook, Instagram, LinkedIn)
Other

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Product Needs and Goals

What type of wholesale products are you interested in?

Bulk
Private Label Finished Goods
White Label Finished Goods
Brand In A Box Finished Goods

What categories are you interested in?

Nutraceuticals / Supplements
Skin Care
Cosmetics
Hair Care
Men's Care
Pet Care

What delivery methods are you interested in?

Tinctures and Liquids
Powders
Capsules and Tablets
Topicals (Balms, Salves, Lotions)
Topicals (Patches)
Beverages
Edibles (Gummies, Candies, Mints)
Bakeables (Baking Mixes)
Smokeables (Buds, Pre-Rolls, Cigarettes)

What certifications are you interested in?

cGMP
NSF
USP
Informed Sport
USDA Organic
ECOCERT / COSMOS
NSF/ANSI 305
Leaping Bunny / PETA Cruelty-Free
Vegan
Fair Trade
EWG
B Corp
ISO 22716
Halal
Kosher
Non-GMO
Third Party Lab COAs

Are you interested in hemp-derived products?

Yes
No
I don't know

Order Frequency

One Time Order
Recurring Order

What is your budget?

Under $10,000
$10,000-$50,000
$50,000-$100,000
Over $100,000

Timeline for Order

Immediate (within 1 month)
1-3 months
3-6 months
TBD

Goals and Objectives

Tell us about your goals and objectives. e.g. launch new brand, target medical patients, expand retail offerings.

Current Challenges

Tell us about the current challenges that you are facing. e.g. sourcing compliant hemp, navigating regulations, consumer education.

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Licensing, Compliance, and Agreements

Hemp-Derived Products Compliance *

I confirm that my business complies with all local, state, and federal regulations regarding hemp-derived products.
I agree to provide proof of hemp licensing upon request.
I do NOT sell hemp-derived products.

Please attach your hemp license(s)

Drag & Drop Files, Choose Files to Upload

If you do NOT sell hemp-derived products, skip to the next question. (.pdf .png .gif .jpg)

Please attach your Supporting Documents

Drag & Drop Files, Choose Files to Upload

Do you have any supporting documents? e.g. licenses, certifications, certificates of analysis, product specs? (.pdf .png .gif .jpg)

Please attach your completed W-9

Drag & Drop Files, Choose Files to Upload

(.pdf .png .gif .jpg)

Please attach your completed Sales Tax Exemption Certificate

Drag & Drop Files, Choose Files to Upload

(.pdf .png .gif .jpg)

Terms and Conditions *

I have read and I agree to the Terms and Conditions
I confirm that the information provided is accurate and that I am authorized to represent my business. I understand minimum order quantities, payment terms, and return policies apply.

I have read and I agree to the Privacy Policy

We respect your privacy. All information collected will be used solely for order fulfillment, product recommendations, and business communications. It will not be shared with third parties without consent.

Refund and Return Policy *

I have read and I agree to the Refund and Return Policy

Shipping Policy *

I have read and I agree to the Shipping Policy

Confirmation by Authorized Representative *

I confirm that the information provided is accurate and that I am authorized to represent this business.

Signature *

Clear Signature

Create Account

Username *

Enter the username you want to use on this website.

Password *

Password

Confirm Password

Save and Resume Later

Your form entry has been saved and a unique link has been created which you can access to resume this form.

Enter your email address to receive the link via email. Alternatively, you can copy and save the link below.

Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted.

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Email *

Contact and Business Information

Product Needs and Goals

Licensing, Compliance, and Agreements

Create Account

SERVICES

PRODUCTS

BRAND IN A BOX

ABOUT US

CONTACT US

Address

Phone

Email

Let's Get Social

Contact and Business Information

Product Needs and Goals

Licensing, Compliance, and Agreements

Create Account

SERVICES

PRODUCTS

BRAND IN A BOX

ABOUT US

CONTACT US

Address

Phone

Email

Let's Get Social

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