Dispensary First-Time Customer Discount Claim Form
Complete the Dispensary First-Time Customer Discount Claim Form below to claim your introductory discount as a first-time dispensary customer.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preferred Dispensary Location
*
Please Select
Downtown
East Side
West End
North District
Other
How did you hear about us?
*
Online Search
Social Media
Friend/Family
Advertisement
Other
Is this your first visit to any of our dispensary locations?
*
Yes
No
Preferred Contact Method
*
Email
Phone Call
Text Message
If you have any comments or requests, please share them here
Upload a photo or document to verify your first-time visit (optional, do not upload sensitive information)
Upload a File
Drag and drop files here
Choose a file
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of
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