Register with LeafLink

Fill out the form below and a LeafLink Team Member will contact you.
Please note that a valid license will be required before a Leaflink Team Member approves registration.

Retailer Account Information

First name

Last name

Username

Email

Password

Company Information

Company Name

Position

Company Street Address

City

State/Province**

Zipcode/Postal Code

Phone

License Information

License Number

License Type

License Number

License Type

License Number

License Type

License Number

License Type

Other Details

How did you hear about us?

Referral Code

Cancel