Create an Account

Additional Information

• Street Address*
• City*
• State*
• Zip Code*
• Phone Number*
• Drivers License # / Passport #*
• Patient ID#*
• Rec Expiration Date*
• Doctor’s Verification Web Site (Please type carefully)*
• Photo of your Doctor’s Recommendation. Please make sure we can read the letters/numbers! (JPG, PNG, GIF files)*

  Allowed Extensions are [jpg,png,gif]
• Photo of your ID. Please make sure we can read the letters/numbers! (JPG, PNG, GIF files)*

  Allowed Extensions are [jpg,png,gif]
• Delivering to an address different than is on your ID? Upload a photo of a document with your name and delivery address on it. (phone/utility bill, hotel receipt, lease) Make sure we can read it! (JPG, PNG, GIF files)

  Allowed Extensions are [jpg,png,gif]
• How did you hear about us?
• I declare under penalty of perjury that the information provided on this membership agreement is true and correct. I further declare under penalty of perjury that I am a medical cannabis patient. Enter “I agree” to sign*