U4EA Farms Solventless Form

Company Name

Date

Customer Name

Phone Number

License #

Email

Who referred you? (optional)

Strain Name

Batch #

Qty. of Material (g)

*All material will be processed into rosin unless requested otherwise*

Strain

# of Batches

Total Qty(g)

Cold Cure / Badder

Fresh Press

Vape Material

Edible Material

Total Extraction Material Wt (g):

Total Extraction Material Wt (Lbs):

Special Note

Attachment (optional)

CERTIFICATE OF TRAINING