Product Listing Form
Please submit one form, for each product to be listed on our website.
We will only consider medicine that is completely organic, free of mold, pests, pesticides and any foreign matter. MUST BE CLEAN !!
We do encourage and respond to patient feedback, for quality control.
You will receive a notice of any and all feedback, concerning your product/s.
Too many complaints may be cause for termination of your product listing.
After you submit this form:
You will receive a verification email and invoice, requesting payment.
Once we have received your payment for product listing:
A. Your product will be placed on our website menu, within 48 hours.
B. After placement on website, you will again receive a email with a, "Test Order Form", as if made by ordering patient.
This is only to verify all information and settings are correct.
When orders for your product are made:
We confirm and verify all information.
The Patient receives an invoice of their order, with instructions for your payment.
Then you will receive an email containing all information listed below.
1. Patient Last Name
2. Delivery Address
3. Product Ordered
4. Quantity Ordered
5. Total Cost $
6. Preferred payment method
Image of Medical Cannabis Rec. and Valid Photo ID, are retained by our office for 60 days.
It is your responsibility to facilitate any further transaction.
We do solicit and encourage feedback from patients.
Click above to read Policies & Protocol
Medical Cannabis Documentation / Certification
Test Results Documentation
Medicine will not be considered without documentation.
Additional Product Information
Quantities offered and acceptable donation.
7 grams $
14 grams $
1 ounce $
2 ounces $
4 ounces $
8 ounces $
1 unit $
2 units $
Put the number "00" for quantities not offered.
A good photo, will increase response.
30 day listing
30 days $45.00
Click all regions below that you service.
State you service?
All 50 states & DC $450.00
Alaska (Become the first provider)
Hawaii (Become the first provider)
Zip Codes Serviced
STATEWIDE please put: *ALL*
USA WIDE please put: USALL
Seperate 5 digit zip codes, with comma.
Payment Forms Accepted
List all Banks, financial Institutions or methods of payment you will accept.
The more options you offer, the greater the success.
Order Payment Methods you will accept?
Bank of America
Bank of New York
BB&T Corp. Bank
Capital One Bank
Goldman Sacks Bank
Green Dot Card
Morgan Stanley Bank
US Postal money order
Wells Fargo Bank
Cashiers Checks & Money Orders
Other forms of payment that you will accept?
Every Order Placed
The ordering patient receives an instant autoresponse copy of their order.
If you desire, we can add an autoresponse, that also includes your payment instructions.
Email for orders to be sent to:
This email is where orders are sent.
Pay to the order of:
This autoresponse also includes a request for the patient to include a copy of their order with their payment.