Mr. Melty Order Request Form
Date requested
-
Month
-
Day
Year
Date
Name of Dispensary
Vendor LLC Name (if different)
Contact Name
Contact phone
Contact email
Vendor license number
Lemonati Pre-Rolls
Gelonade Pre-Rolls
Puro Loco Pre-Rolls
Sunset Sherbert Pre-Rolls
Zkittlez Pre-Rolls
Cost of Pre-Rolls (if different than $2.00/pre-roll)
NOTES
Submit
Should be Empty: