RIC Card-Dark Horse

Arkansas RIC Application

Please complete the following information. This will print at Cantrell Live Scan located at 7509 Cantrell Road, Suite 103A, Little Rock. We are in the business center behind Edward's Food Giant at Cantrell & Mississippi.

We will print the application for you to sign, we will notarize the documents and process your application for you.

The fee for this process is $150 which includes your background check fees and card fees to the Medical Marijuana Commission.
Employee First Name
Employee Middle Name
Employee Last Name
Suffix - if any
Date of Birth

MonthDayYear
Date
State of Birth (OR Country)
Race
Sex
Height:
Feet and inches
Weight
Pounds - estimated
Eye Color
Hair Color
Employee Contact Number
Employee email address
example@example.com
Social Security Number
State of DL/ID Issuance - Or Country if not US
Drivers License Number (Or passport #)
Number
ID Expiration Date DDMMYY

MonthDayYear
Date
Address

Street and Apt # (if any)

Street Address Line 2

CityState

Zip Code
Last 4 digits of SSN
Should be Empty: