Marijuana Cards Arizona

1
Full Name* This field is required.Enter in your name as it appears on your drivers license- If you have two last names please include both last names in the application
First Name
Last Name
2
WARNING: There may be potential dangers to fetuses caused by smoking or ingesting marijuana while pregnant or to infants while breastfeeding,” “WARNING: Use of marijuana during pregnancy may result in a risk being reported to the Department of Child Safety during pregnancy or at birth of the child by persons who are required to report”
3
Phone Number # * This field is required.Please enter a good number for the doctor and processing team to reach you at.
Phone number
4
How did you hear about us?* This field is required.Friends are entered into a raffle for free approval paperwork on their next renewal, businesses get extra goodies delivered!
5
Birth Date* This field is required.
Month
Day
Year
6
EmailFor Copy of Application
example@example.com
7
Address* This field is required.All the cards are digital but we need to ensure you are a resident of Arizona
Street Address
Street Address Line 2
City
State
Zip Code
Please Select
Please Select
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The Bahamas
Bahrain
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Fiji
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Israel
Italy
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Japan
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Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
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Senegal
Serbia
Seychelles
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eSwatini
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Yemen
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Zimbabwe
Other
USA
8
Is this your first or a renewal card?
First
Renewal but I am expired
Renewal
9
Are you receiving food stamps?
YESNO
10
Where is your pain located and how many years have you been experiencing it?
Huge
Large
Normal
Small
Ok
Ok
11
State FeeThe state fee of 150$ will be managed together with Crystal or on your side in AZDHS. We are not in any relation to AZDHS, we simply help you manage our documents into your portal to ensure you complete the process. We cannot pay AZDHS until we upload the doctors documents. Please continue to the next screen to submit this application to Dr Maria and she will prepare your approval documents for AZDHS. The TOTAL fee for your 2yr card is $255 after taxes. Assistance in the state website is free, assistance varies per patient terms on website.
YESNO
12
Signature for AttestationThe state requires you to fill out a statement saying you will not share medical marijuana with anybody who is not in the program, it is their attestation. We can fill the form for you and place your signature on the form showing you agree. Patient to patient is ok; never is it ok for a medical patient to accept money or make purchases for recreational users or share medical products. By placing your initials or signature in the box we will prepare your attestation with your signature providing you understand and agree to the statement.
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13
My Products
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My Bag
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$20
Quantity:1
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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ORDER SUMMARY
TaxUSD
SubtotalUSD
Total costUSD
Certified & Approved Guaranteed97 plus tax. When this is done, hang tight and wait for Crystal to reach out usually within an hour
$97.00Edit
Back
ExpeditedGet the certification twice as fast literally within minutes, state processing remains the same but you get the clock moving faster than the rest.
$20.00Edit
Back
1
1
Quantity
Enter Coupon
Total cost $0.00
Payment Methods
Credit Card
First Name
Last Name
Cash App
After submitting the form, you will be redirected to the Cash App Pay to complete the payment process.
Google Pay
After submitting the form, you will be redirected to the Google Pay to complete the payment process.
Apple Pay
After submitting the form, you will be redirected to the Apple Pay to complete the payment.
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