Verification Form

1

Name* This field is required.

2

Instagram Name * This field is required.(If you do not have IG, Please enter your Twitter, Snapchat or “N/A” )

3

Phone Number* This field is required.

Please enter a valid phone number.

4

City Of Residence* This field is required.

South Florida Only!

5

Upload Selfie (ONLY IF INSTAGRAM IS PRIVATE)

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Browse Files

Or if you don’t have photos/Instagram/Snapchat

6

Were you referred by anyone? If yes, Who?

If No, Skip.

7

Please verify that you are human* This field is required.

8

LAST STEP: Safety Waiver/Liabilities* This field is required.After you submit this form, you will be and official Cloud 954 member & redirected to our SHOP!

WARNING: THESE PRODUCTS CONTAINS MARIJUANA, A SCHEDULE I CONTROLLED SUBSTANCE. KEEP OUT OF REACH OF CHILDREN AND ANIMALS. MARIJUANA PRODUCTS MAY ONLY BE POSSESSED OR CONSUMED BY PERSONS 21 YEARS OF AGE OR OLDER UNLESS THE PERSON IS A QUALIFIED PATIENT. THE INTOXICATING EFFECTS OF MARIJUANA PRODUCTS MAY BE DELAYED UP TO TWO HOURS. MARIJUANA USE WHILE PREGNANT OR BREASTFEEDING MAY BE HARMFUL. CONSUMPTION OF MARIJUANA PRODUCTS IMPAIRS YOUR ABILITY TO DRIVE AND OPERATE MACHINERY. PLEASE USE EXTREME CAUTION.MEDICINAL USE ONLY! NOT LIABLE FOR MISUSE OR PRODUCT ABUSE!