WE NEED PROVIDERS!!!
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
1 product per form.
Rick Simpson Oil
Strain or Name?
A good photo, will increase response.
Weight or count per Pack?
Additional Product Information.
or Quantity price breaks?
Email for orders to be sent to?
This email is where orders are sent.
State you service?
Alaska (Become the first provider)
Hawaii (Become the first provider)
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
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?
30 day listing
Listing Start Fee $75.00
Click all regions below that you service.
30 days $25.00
60 days $45.00
90 days $60.00
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.