CONCENTRATES MORE FLOWERS EDIBLES PROVIDER

Thank you for making an appointment to have your product evaluated! We look
forward to meeting with you. Here are some things to know before you come in...
For FLOWERS, please bring 1 pound (454 grams) per strain. We will evaluate up to
two strains per appointment (total of 2 lbs.).
For CONCENTRATES, please bring 28-60 grams. We will evaluate 2 per appointment.
FLOWERS
EDIBLES
MORE
PROVIDER INFORMATION
First Name: ________________ Appointment Date & Time: _______________
Email Address: __________________________________________________
CONCENTRATES
Phone Number: ____________________ OK to leave message? [ ] Yes [ ] No
Has your product been lab tested? [ ] Yes [ ] No
FLOWERS
STRAIN/GENETICS
Strain Name: ____________________________________________________ Quantity Available: ____________________
Parent Genetics: _____________________________________________________ Harvest Date: ____________________
[ ] Indica [ ] Sativa
[ ] Hybrid For Hybrids, please list percentage breakdown of Indica vs. Sativa: ___________________________________________
CULTIVATION METHOD
Grown from: [ ] Seed [ ] Clone
[ ] Indoor
[ ] Outdoor [ ] Greenhouse
Humidity Range/Control: ________________________
Number of Lights/Wattage: ___________________________
Temperature Range/Control: _____________________
Water Source/Filteration: _____________________________
Grow Medium: ________________________________
Pest Control Method/Products Used: ____________________
Nutrients used during vegetative growth cycle: _______
_________________________________________________
____________________________________________
Flushing Method/Duration:____________________________
____________________________________________
Storage & Drying Method/Duration _____________________
Nutrients used during flowering cycle: ______________
Tell us about yourself as a cultivator and your techniques. What
____________________________________________
sets you apart? ____________________________________
____________________________________________
________________________________________________
GROWING REGION
Please list the appellation in which your cannabis was cultivated (refer to back page) ____________________________________
CONCENTRATES
STRAIN/GENETICS
Product Name: ________________________________
Cannabis Strains Used: _______________________________
Genetics: ___________________________________________________________ [ ] Indica [ ] Sativa [ ] Hybrid
[ ] Bubble Hash
[ ] Kief
[ ] Oil
[ ] Shatter
[ ] Wax
[ ] Other: _____________________
TYPE
EXTRACTION METHOD
Please describe your extraction method in detail. Include a detailed list of all products and apparatus used during the process:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
EDIBLES
Product Name: _________________________________________________ Price per unit: _________________________
TYPE [ ] Baked Good [ ] Candy
[ ] Savory
[ ] Capsules/Tinctures
[ ] Other: _________________________
Flavor(s) Available: ______________________________
Additional Products Available: _________________________
_____________________________________________
_________________________________________________
INFUSION METHOD/INFORMATION
DOSAGE _______ mg THC _______ mg CBD
Cannabis Strain(s) used: ____________________________________________ [ ] Indica [ ] Sativa
[ ] Hybrid
Please describe your infusion method in detail. Include a detailed list of all products and apparatus used during the process:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Do you work in a licensed commercial kitchen? [ ] Yes [ ] No
Are you Food Safety Certified? [ ] Yes
[ ] No
OTHER For cannabis and related products that fall outside of the categories above...
Product Name: ____________________________________ Description: _______________________________________
[ ] Topical Treatments
[ ] Seeds
[ ] Other: __________________________________________________
TYPE
What is your cannabis appellation?
NORTH COAST
APPELLATIONS
Bodega
Cape Mendocino
Eel River
Eureka Plane
Klamath River
Mad River
Mendocino Coast
Redwook Creek
Rogue River
Russian River
Smith River
Trinity River
Winchuck River
SAN FRANCISCO BAY
APPELLATIONS
Bay Bridges
Marin Coastal
San Mateo
San Pablo
Santa Clara
South Bay
Suisun
CENTRAL COAST
APPELLATIONS
Big Basin
Bolsa Neuva
Carmel River
Carrizo Plain
Estero Bay
Estrella River
Pajaro River
Salinas
San Antonio
Santa Barbara Channel
Island
Santa Lucia
Santa Maria
Santa Ynez
South Coast
SACRAMENTO RIVER
APPELLATIONS
American River
Ball Mountain
Bear River
Butte Creek
Cache Creek
Colusa Basin
Cortina
Eastern Tehama
Feather River
Lakeview
Marysville
McCloud River
Mountain Gate
Pit River
Putah Creek
Redding
Sacramento Delta
Shasta Bally
Shasta Dam
Stony Creek
Tehama
Uper Elmira
Upper Sacramento
Valley-American
Valley Putah-Cache
Whitmore
Yuba River
SAN JOAQUIN
APPELLATIONS
Ahwahnee
Carbona
Delta-Mencota Canal
Gopher Ridge
Lower Calaveras
Mariposa
Merced River
Middle Sierra
Middle West
North Diablo Range
North Valley Floor
San Joaquin Delta
San Joaquin River
San Joaquin Valley Floor
Stanislaus River
Tuolumne River
Upper Calaveras
NORTH
COAST
NORTH LAHONTAN
APPELLATIONS
Cow Head Lake
Duck Flat
East Fork Carson River
East Walker River
Lake Tahoe
Little Truckee
Madeline Plains
Smoke Creek
Surprise Valley
Susanville
Truckee River
West Fork Carson River
West Walker River
SOUTHERN CALIFORNIA
APPELLATIONS
South Lahontan
South Coast
Tulare Lake
Colorado River
NORTH
LAHONTAN
SACRAMENTO
RIVER
SAN FRANCISCO
BAY
SAN JOAQUIN
RIVER
CENTRAL
COAST
TULARE
LAKE
SOUTH
LAHONTAN
SOUTH
COAST
COLORADO
RIVER