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Requests must be made by or on behalf of a current resident of California, Colorado, Connecticut, Florida, Montana, Oregon, Texas, Utah, or Virginia.

Certification of Residency or Authorized Agent
By pressing “submit,” I certify that I am a resident of the location above or that I am an authorized agent of a resident of the location above and that all information I have submitted is true and accurate.

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Please provide the following information so we may identify you, or if you are requesting on behalf of someone else, please provide their information.


Please note that you must provide all of the required information (marked by an asterisk) to enable us to process your request or, for agents, provide documentation demonstrating your authorization to act on an individual’s behalf.

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Do not sell or share my personal information

Limit the use of my sensitive personal information (California only)

First Name *

Last Name *

Email associated with your Roundhouse Provisions Account or Purchase *

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