The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

Hemp Derived Cannabinoid Products Business Registration Change Form

If you have registered as a hemp derived cannabinoid product business and have changes to your business, please enter the information below and select and complete each of the options that apply to your change(s) below.

A Hemp Derived Cannabinoid Products Registration is tied to the location of the business. In the event that a business is sold, but will continue to operate at the same location, the business may transfer the registration using this form.

Businesses seeking to register for the first time will need to use the registration form when it reopens on June 2.

Thank you!

Business Name

* must provide value

Business Owner's Name

* must provide value

Business Record ID (this number is on the registration email you received)

* must provide value

Business Owner's Email

* must provide value

Confirm Business Owner's Email

* must provide value

Emails Do Not Match Yet

Do you wish to cancel your registration?

Yes

Business Owner's Information Changes
Please note: Business ownership changes may be made to a registered business only in the event of a business sale in which the complete corporate entity is transferred without any alterations to the current tax ID.
If ownership of a business is changed, the new owner must demonstrate they meet this requirement by either: 1) Documenting the ownership change with the MN Secretary of State, or 2) Providing a fully executed Purchase Agreement showing corporate entity transfer to the OCM.

Business Owner's Full Name

Business Owner's Email

Business Physical Address

Business Owner's Phone Number

Business Owner's County

New Business Owner's Email

New Business Owner's Phone Number

New Business Owner's Full Name

New Business Physical Address

New Business Physical Address City

New Business Physical Address Zip Code

New Business Physical Address State (ex. MN)

New Business Physical Address County

New Business Website

Type of Business

Convenience Store

Bar

Restaurant

Exclusive Liquor Store

Hemp/Edible Cannabinoid Store

Hair or Nail Salon/Barbershop

Grocery Store

Smoke Shop

Brewery/Distillery

Manufacturer/Wholesaler

Other

reset

Describe Type

Current Hemp Derived Cannabinoid Products Offered for Sale (select all that apply)

Edible Cannabinoids (food)

Beverages

Topicals

Other

Describe Other Products

Day	Open?	Opening Time	AM\PM	Closing Time	AM\PM
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

I, the undersigned, attest that I am an authorized representative with signature authority for the business listed above and that the business is in compliance with all requirements described in MN Statute 151.72 and all other applicable state and local laws and ordinances. I further attest that the business will stay in compliance with MN Statute 151.72 and all other applicable state and local laws and ordinances.

* must provide value

Yes

reset

Full Name of the person completing the form

* must provide value

Email of the person completing the form

* must provide value

Confirm Email Address

Emails do not match yet.

Date

M-D-Y

Comments

Saved on Network

Yes

reset

Date Sent to OCM Staff

D-M-Y

Office use

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.