ORDER REQUEST

Chemo Days and Pain Free Nights

Plant Based Medicine Made by the People for the People

CHEMOD DAYS TINCTURE ORDER REQUEST FORM

CHEMODAYS TINCTURE ORDER REQUEST FORM

First - Last Name*

Shipping Address*

Province*

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Product Order Description and Quantities Wanted* CBD TINCTURE - (CBD 2000mg) - 50ML- $50.00
THC TINCTURE - (THC 2000mg) - 50ML - $75.00
CBG TINCTURE - (CBG 2000mg) - 50ML - $75.00
4:1 - THC/CBD TINCURE - (THC 2000mg) / ( CBD 400mg) - 50ML - $75.00
FRANKINCENSE & MYRRH TINCTURE - 50ML - $75.00
WOOF TINCTURE - (CBD 2000mg) - 50ML - $75.00
MEOW TINCTURE - (CBD 2000mg) - 50ML - $75.00
SLEEP TINCTURE - (Melatonin 2000mg) - (THC 1000mg) - (CBD 1000mg) - 50ML - $99.00

List Quanties of Each Ordered Above

Canadian - Provincial - Cancer Care Number

Referal From

Cancer Type or Illnesses that medicine is used for

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