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2. Please complete this form and a copy will be sent to the Board of Selectmen upon submittal.  Thank you!

4. Date
   Date
6. Name*
7. Company Name
9. Business Phone Number
10. Cell Phone Number*
12. Email*
14. Mailing Address*
16. Business Interest

    1. Marijuana Retailer
    2. Craft Marijuana Cooperative
    3. Cultivator
    4. Micro-Business
    5. Product Manufacturer
    6. Research Facility
    7. Testing Laboratory
    8. Transporter
18. Property Considered
20. Requests/Comments
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field