Returns Report + Credit Request Form and SAE Reporting

PLEASE READ BEFORE COMPLETING THIS FORM.

Click here for GTI’s Product Return Policy.

All returns/credits are due on the last day of the month, and will be processed on the first day of the following month. Example: March returns are due on March 31, and will be processed April 1. Anything submitted on or after April 1 will be processed May 1.

Please do not submit multiple Product IDs as one entry. Each Manufacturer’s Product ID should have it’s own entry. Please do NOT submit “test” entries. Please do NOT submit a duplicate to correct a mistake, if you made a mistake, please contact [email protected] with the details and what needs to be corrected.

Serious Adverse Event (“SAE”): A serious experience associated with the use of cannabis where the outcome was death, life-threatening, hospitalization, disability or permanent damage, congenital anomaly/birth defect; required intervention to prevent permanent impairment or damage, or any other important medical event. Examples of important medical event include allergic bronchospasm or convulsions/seizures requiring intensive treatment in an emergency room or at home. If an SAE has occurred complete this web form and complete and upload the SAE Report Form (link will appear below when SAE is chosen).

This Form is for GTI (and its subsidiaries) Products Only, IF A PRODUCT IS NOT LISTED, please do not choose a different product–contact [email protected]. Please include the store name and address and the full name of the product including weight/dosage and class/flavor.

"*" indicates required fields

Name

This field is for validation purposes and should be left unchanged.

This field is hidden when viewing the form

Store Customer ID

State*

IMPORTANT NOTE: If after choosing State, the dropdown for Store Name does not load, please clear the browser's cache. Then, close and re-open the browser before trying again.

Store Name*

Submitted By*

First Name Last Name

Date of Purchase*

Store's Transaction ID*

The order number as it appears on the purchaser's receipt.

Purchaser Name

Please enter only one person's name.

First Name Last Name

Purchaser Phone

Please enter only one phone number.

Purchaser Email

Brand*

This form is for GTI and subsidiary brands only. IF A BRAND, FORM, PRODUCT TYPE, OR PRODUCT DETAIL IS NOT LISTED, please contact [email protected]. Please include the store name and address and the full name of the product including weight/dosage and class/flavor.

Form*

Product Type*

Product Details*

Manufacturer's Product ID (ONE NUMBER ONLY)*

DO NOT put product names or multiple numbers here. ONLY ONE Manufacturer's Product ID per entry. Use the WHOLESALE (Parent/Batch/Lot) number, NOT the retail (not SKU or Transfer) number. Please include dashes. USE THE COMMENT SECTION TO PROVIDE ADDITIONAL INFORMATION.

Manufactured By*

PLEASE CHOOSE THE LICENSE NAME PRINTED ON THE PACKAGE.

Quantity*

WHOLE NUMBERS ONLY, PLEASE. The number of units being returned. Ex: If a single 10-pack of pre-rolls is returned, enter 1. If three individual cartridges are returned, enter 3.

Please enter a number from 1 to 999.

Percentage of Product Remaining in Container*

WHOLE NUMBERS ONLY, PLEASE. Approximately how full is the returned product? Ex: If a 10-pack of pre-rolls is returned with 5 missing, enter 50. If three cartridges are returned unused, enter 100.

Please enter a number from 0 to 100.

Was the Patient/Caregiver Provided a Replacement or Credit?*

YES

Return Reason*

Return also means exchange or credit given without the product being physically returned due to state regulations.

ACTION REQUIRED: Please click here to download adverse event form. Complete it and upload as a Supporting Document below. Serious Adverse Event means a serious experience associated with the use of cannabis where the outcome was death, life-threatening, hospitalization, disability or permanent damage, congenital anomaly/birth defect; required intervention to prevent permanent impairment or damage, or any other important medical event. Examples of important medical event include allergic bronchospasm or convulsions/seizures requiring intensive treatment in an emergency room or at home.

Comments?*

Please provide detailed comments to help us better understand the Return Reason/Quality Issue. Submissions with DETAILED comments are more likely to receive credit approval. IF A SERIOUS ADVERSE EVENT--PUT SHORT COMMENT HERE AND COMPLETE AND ATTACH THE FORM (Link above when SAE chosen as return reason).

Please attach Supporting Document(s) or Photo(s).

IF YOU ARE REPORTING A SERIOUS ADVERSE EVENT ("SAE"), YOU MUST ATTACH THE SERIOUS ADVERSE EVENT REPORT FORM. (See link above, shows when Serious Adverse Event is chosen as the Return Reason.)

Drop files here or

Accepted file types: pdf, jpg, png, doc, Max. file size: 128 MB.