EmailMeForm
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. Product Ordered
3. Quantity Ordered
4. Total Cost $
5. 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.
A courier will be assigned, an appointment made to pick up products twice a week.
We do solicit and encourage feedback from patients.
Click above to read Policies & Protocol
Name
*
First
Last
Email
*
Medical Cannabis Documentation / Certification
Product Name
*
Product type
*
Cannabis Flower
CBD
Concentrate
Edible
Gear
Vape Cartridge
Other
Test Results 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.
Product Photos:
*
Add File
Good photos, will increase response.
Start up fee
*
Product listing $40.00
This is a ONE TIME ONLY fee for adding product to menu.
30 day listing
*
30 days $35.00
60 days $55.00
90 days $85.00
Click all regions below that you service.
State you service?
*
Alabama
Alaska (Become the first provider)
Arizona
Arkansas
California
Colorado
Connecticut
DC
Delaware
Florida
Georgia
Hawaii (Become the first provider)
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Codes Serviced
*
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
BitCoin
Bluebird Card
Capital One Bank
CASH
Chase Bank
CitiGroup Bank
First Bank
Goldman Sacks Bank
Green Dot Card
HSBC Bank
Morgan Stanley Bank
Pay Pal
PNC Bank
SunTrust Bank
US Bank
US Postal money order
Wells Fargo Bank
Western Union
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.
Confirm
Pay to the order of:
*
First
Last
Payment Instructions:
P.O. BOX
Details
Needed information.
ETC.
*
This autoresponse also includes a request for the patient to include a copy of their order with their payment.