Applicant InformationCompany Name*Web Address*UBI*License #*Phone*Corporate Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Contact* First Last Does your licensed I-502 business have a bank or credit account?*YesNoProduct InformationProduct Categories* Indoor-Grown Flower Outdoor-Grown Flower Greehouse-Grown Flower CO2 Hash Oil Topicals BHO Liquid Edibles Solid Edibles Cartridge/Tanker High CBD Solventless Extracts (Bubble Hash, Hash, Rosin, Kief)Check all that apply.What is your asking price per gram and/or unit?*Package Sizes* 1g 2g 3.5g 4g 7g 14g 28gFor flower only. Check all that apply.Do you offer Prerolls?*YesNoIf YES, are they made with: Flower Trim MixFlower Grow Medium Soil Hydroponics OtherCheck all that apply.Watering Hand IrrigationCheck all that apply.Trimming Hand-Trimmed MachineCheck all that apply.What kind of lighting do you use?Describe your curing process.Describe your flushing process.For applicable product, what are the dominant terpene profiles?Did you previously sell through medical?*YesNoWhat Seattle and outlying area retailers within a 25-mile radius of Uncle Ike’s currently carry your product(s)?Describe your target consumer:What distinguishes your product(s) from those that are similar?Please list all pesticides applied to your marijuana and/or applied to the marijuana used in your product.Per WAC 314-55-105, all pesticides must be disclosed to the end consumer.Please list all nutrients applied to your marijuana and/or applied to the marijuana used in your product.In addition to meeting all label and warning requirements in WAC Chapter 314-55-105, are you able to deliver product affixed with lot-specific barcodes and Uncle Ike’s name and UBI?YesNoHave you ever, do you presently, or do you reasonably anticipate that you will in the future procure any marijuana or marijuana product from other producers and/or processors?*YesNoIf yes, would you include these producer and/or processor name(s) and UBI(s) on your package labels in accordance with 314-55-105 WAC?YesNoIf yes, please describe how you vet or would vet your producer and/or processor partners for pesticide use and other compliance issues.Are you willing to add Uncle Ike's as an additional insured to the product liability portion of your general liability insurance policy?*YesNoAre you able to provide high-resolution images of your product for in-store promotional purposes?YesNoAre you able to provide detailed strain and/or product descriptions?YesNoSignatureI certify that the above information is true and correct to the best of my knowledge. By checking the signature checkbox below I certify that I am electronically signing this application.Signature* Accept SignatureName First Last Date MM DD YYYYPlease upload/attach a current inventory list. Drop files here or This iframe contains the logic required to handle Ajax powered Gravity Forms.