Thank you for your interest in our marijuana delivery services serving Las Vegas. To request a delivery, please fill out the form below to setup your account for free. We will follow up with you within the hour to complete and confirm your information. After your information is verified, we will be able to begin delivery service to your location.

Request a Delivery – Free

All fields marked with (*) are required.

First Name (*)

Last Name (*)

Delivery Address (*):

City (*):


Zip Code (*):

Email Address (*):

Phone Number (*):

Are You Legally Eligible to Accept a Marijuana Delivery? (*):
(All new patients/customers will be required to provide proof of eligibility)

Are You Less Than 18 Years of Age? (*):
(We are requried to comply with federal, state, or provincial law.)

Personal Message:

Referred By:

Marijuana Delivery Form