Cannabis Age Verification Renewal Form
Use this form to renew your age verification for cannabis-related access or membership. Please provide accurate current information and any requested verification details.
Applicant Information
Full Legal Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Preferred Contact Method
*
Email
Phone
Mail
Other
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Age Verification Details
Type of age-verification document
*
Driver's license
State ID
Passport
Other acceptable photo ID
Last 4 digits of document number
Issuing state or country
*
Document expiration date
*
-
Month
-
Day
Year
Date
Has the document changed since last verification?
*
Yes
No
Upload clear photo of the front and back of your current acceptable ID
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Renewal Status and Eligibility
Reason for renewal
*
Expired verification
Updated personal details
Lost account access
Routine re-verification
Other
Current cannabis access or membership status
*
Please Select
Active
Pending renewal
Expired
Suspended
Not currently enrolled
Other
Age attestation
*
I attest that I am at least the minimum age required by the business
Contact and Notification Preferences
Preferred renewal outcome delivery method
*
Email
SMS
Phone call
Mail
In-person pickup
Best time to contact
Communication preferences or accessibility needs
Submit Renewal
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