This form serves as identification and meets the DEA requirements for first time Ephedrine customers. We are requesting that you fill out this form in its entirety. Your order cannot be processed if any missing fields or information is incomplete.
Please Note: Once this form is completed and your Information is on file, you will not be required to re-submit this form for future orders unless regulations change. All information must match; your shipping address, the address on your driver’s license, and the address you supply on this form. Complete the entire form. Any missing, or misleading information and your order will not be processed. Print the entire form and sign with the credit card holder’s signature on the line by the (X). Please include a copy of your Passport or Driver’s License or State I.D. Card.
There are 3 ways to get us your required information:
- Scan document and your ID and email to ephedrine@LiveLeanToday.com
- Take a clear photo of the document and your ID and email to ephedrine@LiveLeanToday.com
- Mail the document and copy of ID to Live Lean Today 207 N. Gilbert rd. Gilbert, AZ 85234
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