Kiva — Terra Bites — Chocolate Covered Espresso Beans (100mg)

Your Email Address *

Create Password *

Which type of account would you like to create?* Medical

First Name*

Last Name*

Sex* Choose One Male Female Others

Phone *

Date Of Birth (MM/DD/YYYY)*

Medical Reccomendation Type Third Party / Non-State Card Holder
You have a Doctor's Recommendation to use medical marijuana. Your rec is stored and verified by a privately run, third party database. If you are unsure, you are most likely are a third party, non-state card holder.MMIC / State Card Holder
You have a physical Medical Marijuana Identification Card issued by the State of California. Your card can be verified through the California data base found here: calmmp.ca.gov. This is the much less common. * Medicinal - Third PartyMedicinal - MMIC

Rec # *

Rec Expiration Date (MM/DD/YYYY) *

Doctor First Name

Doctor Last Name

Rec Verify Website

Rec Verify Phone #

Medical License # *

Add Recommendation ID *

State* Select State AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

DL No*

DL Expiration Date (MM/DD/YYYY)*

Add a photo of your Government Issued ID (passport ok)*

What lead you to sign-up? Select lead source google word of mouth Weedmaps walk in radio instagram Yelp insta

Receive email promotions and updates Receive SMS marketing and updates * I accept Agreement