Licensed Retail Online Order Form
Complete the brief form below and your order will be on its way!
Email address *
First and Last Name *
Your answer
Dispensary Name *
Your answer
Company Name *
Your answer
Intake Contact Name *
Your answer
Preferred Intake Contact Information *
Your answer
Product *
Required
Quantity *
If you would like to place an order for both samples and cases, please check both applicable boxes
Required
When Would You Like Product Delivered?
We deliver Monday, Wednesday and Friday. If no date is specified, we'll simply deliver at the next available delivery day!
MM
/
DD
/
YYYY
Retail Intake Delivery Address *
Your answer
Questions, Comments or Instructions
Your answer
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