Flower Sample Request
This form is for dispensary purchase managers who are interested in trying our flower.

Please provide accurate contact information below so we can properly coordinate your delivery.

Thank you!

Dispensary Name: *
Your answer
Dispensary License Number: *
Your answer
Dispensary Address (Where samples will be delivered): *
Your answer
Purchasing Manager Name: *
Your answer
Purchasing Manager Phone Number: *
Your answer
Purchasing Manager Email Address: *
Your answer
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