Grower Recommendation

First Name *

Last Name *

Probation / parole

Email *

Phone Number *

Driver license number*

How many plants would you like to grow? 15 - 35 Plants - $8535 - 60 Plants - $15060 - 85 Plants - $200Up to 99 Plants - $250

Would you like to be contacted via Skype, FaceTime, or phone? * Would you like to be contacted via Skype, FaceTime, or phone? Skype FaceTime (uses phone number above) Call (uses phone number above)

What day would you like the doctor to contact you? *

What time would you like the doctor to contact you?

Upload / Take Picture of Driver's License * Select file

How did you hear about us? [Please select] Internet Weedmaps From a friend Other

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