Mini Retro Swirl Rolling Tray

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Which type of account would you like to create?* Recreational
Medical

First Name*

Last Name*

Sex* Choose One Male Female Others

Phone *

Date Of Birth (MM/DD/YYYY)*

Medical Reccomendation Type Third Party / Non-State Card Holder
You have a Doctor's Recommendation to use medical marijuana. Your rec is stored and verified by a privately run, third party database. If you are unsure, you are most likely are a third party, non-state card holder.MMIC / State Card Holder
You have a physical Medical Marijuana Identification Card issued by the State of California. Your card can be verified through the California data base found here: calmmp.ca.gov. This is the much less common. * Medicinal - Third PartyMedicinal - MMIC

Rec #

Rec Expiration Date (MM/DD/YYYY)

Doctor First Name

Doctor Last Name

Rec Verify Website

Rec Verify Phone #

Medical License #

Add Recommendation ID

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DL No*

DL Expiration Date (MM/DD/YYYY)*

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