Order Form Provider Listing
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.
  • Click above to read Policies & Protocol
  • A good photo, will increase response.
  • MG?
  • $ .
  • This email is where orders are sent.
  • 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.
  • Cashiers Checks & Money Orders
  • Click all regions below that you service.
  • After you submit this form:

    You will receive a verification email and invoice, requesting payment.

    Once listing payment has been received:
    Your product will be placed on our website menu, within 48 hours.
    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:
    You recieve orders instantly to your email, containing all information listed below.

    1. Patient Name
    2. Delivery Address
    3. Email Address
    4. Product Ordered
    5. Quantity Ordered
    6. Total Cost $
    7. Preferred payment method
    8. Image of Medical Cannabis Rec. and / or Valid Photo ID

    It is your responsibility to facilitate any further transaction.
  • 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.
  • This autoresponse also includes a request for the patient to include a copy of their order with their payment.