• Name

  • Please list your Instagram or Facebook
  • Contact Info

  • Please list the best phone number for text & calls
  • About Yourself

  • Give us a little info on what you are looking for. Rosin? Capsules? Pain Relief? Sleep Aid? etc...
  • Type of Membership

    Please choose which type of client you are:
    This is for Caregivers or Shops who want to work together and get wholesale pricing
    Our Patient Direct Program
  • Please upload your current medical card or Caregiver Card to activate your account
  • Please upload your drivers license to verify your medical card
  • By clicking here I agree to allow Roxi Gray LLC review all my data to become a member of their services.