PrNtrKmt Donation Center
Application Form
Religious Cannabis / Medical Marijuana Necessity Cards & Stickers

just print this form and place your order
Print: On PC Keyboard, Hold Control Button & Press P, as in Print / On Mac, It's Command P
REQUIRED: Please print legibly and remember to sign the document


Name: _____________________________________________________________________________________
(Write your full name as it will appear on the mailed package.)


Date of Birth: _______________________________________________________________________________
(You must be of legal age in your area (18 in the U.S.)


I, (Name) ____________________________________________________________________________________

Check One or Both

________ I have a sincerely held religious belief that cannabis is manditory in prayer.

________ I have a current doctors recommendation for medical marijuana.



_____________________________________________________________________________________________
Signature:

_____________________________________________________________________________________________
Mailing Address:

_____________________________________________________________________________________________
Phone Number

_____________________________________________________________________________________________
E-mail Address:


Now place your order

After you’ve placed your order, come back to this application form,
fill it in and send this document in a stamped envelope addressed to:

Pr Ntr Kmt
c/o michaelm
1024 Bayside Dr. #420, Newport Beach, CA 92660-7462 United States of America (949) 566-0001


Your order will be ready for shipping within 24 hours.
It will be sent on the same day we receive your completed application form.
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