Customer Registration
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Are you a medical marijuana patient?
No, but I'm over 21!
I Have My Physician's Recommendation!
I Have An MMIC issued by the CA Dept. of Public Health!
(Tax Exempt Customers)
Rec Information
Click Here to Upload Rec
(required)
Rec ID Number
(required)
Rec Expiration Date
Rec URL
(required)
MMIC Information
Upload MMIC
(required)
MMIC ID Number
(required)
MMIC Expiration Date
Rec ID Number
(required)
ID Image
Upload a photo of the FRONT of your ID
Click Here to Upload ID
(required)
Back of ID
Take a clear photo of the barcode located on the BACK of your ID
Click Here to Upload Barcode
(required)
Personal Info
State ID Number
(required)
First Name
Last Name
Street Address
Apt Number
City
State
Zip
Date of Birth
ID Expiration
Male
Female
Contact Info
email
Email
(required)
phone
Phone
(required)
I agree to the
terms & conditions
How'd you hear about us?
Referral
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