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 [Format]Marijuana Order

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Steven Ramos
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Join date : 2015-10-12

PostSubject: [Format]Marijuana Order   Tue Feb 09, 2016 1:22 am

Marijuana Order

Customer Information

Full Name:
Age:
Address:
What are you planning on using marijuana for?
[]Medical Use
[]Recreational Use (N/A)

If checked medical use answer the following questions below.

What is your disability?:

Expiation of why you want it. (100 words):

Delivery Information

How many grams?:

Type of delivery:
[]In store pickup
[]Delivered straight to the address

Customer Signature:

Code:

[center][size=18][u]Marijuana Order[/u][/size][/center]

[u][b][size=16]Customer Information[/size][/b][/u]

[b]Full Name:[/b]
[b]Age:[/b]
[b]Address:[/b]
[b]What are you planning on using marijuana for?[/b]
[]Medical Use
[]Recreational Use (N/A)

[b]If checked medical use answer the following questions below. [/b]

[b]What  is your disability?:[/b]

[b]Expiation of why you want it. (100 words):[/b]

[size=16][u][b]Delivery Information[/b][/u][/size]

[b]How many grams?:[/b]

[b]Type of delivery:[/b]
[]In store pickup
[]Delivered straight to the address

[b]Customer Signature:[/b]
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