Name *

(legal entity)

First Name

Last Name

Billing address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Delivery address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Type of FLOWER desired:

(If you have more than one choice, please add it to notes below)

Flower Mass

Trimmed A Grade

Trimmed B Grade

Smalls / Pre Rolls

Hand Trim

Type of HEMP BIOMASS desired

(If you have more than one choice, please add it to notes below)

Shucked

Milled

Pelletized

HEMP EXTRACTS

( Please select all that apply)

Full-spectrum

Winterized full-spectrum

Zreo-T broad-spectrum

CBD Distillate

CBD Isolate

CBD Water soluble

Terpenes

Desired date of pick up / shipment:

MM

DD

YYYY

Purchase Frequency:

one-time

bi-weekly

monthly