Form MJ17-5205 "Supplemental Form: Retailer Home Delivery Registration" - Oregon

What Is Form MJ17-5205?

This is a legal form that was released by the Oregon Liquor Control Commission - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 4, 2019;
  • The latest edition provided by the Oregon Liquor Control Commission;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form MJ17-5205 by clicking the link below or browse more documents and templates provided by the Oregon Liquor Control Commission.

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Download Form MJ17-5205 "Supplemental Form: Retailer Home Delivery Registration" - Oregon

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OREGON LIQUOR CONTROL COMMISSION
Supplemental Form:
Retailer Home Delivery Registration
What is this form?
A recreational marijuana retailer may register with the OLCC to deliver marijuana items to a customer at that customer’s
place of residence. Deliveries may only be performed within the same local jurisdiction as the retailer’s licensed premises,
except that a retailer with this registration may deliver marijuana items to a patient or a patient’s designated primary
caregiver at an individual’s residence.
Section 1 – Retailer Information
Application/License ID:
Applicant/Licensee Name:
Contact Name:
Contact Phone:
Contact Email:
Section 2 – Acknowledgements
Registered Retailers:
May deliver marijuana items to a residence between the hours of 8:00 AM and 9:00 PM.
May deliver marijuana items only to a location that is a residence, such as a house or apartment.
May deliver marijuana items only pursuant to a bona fide order.
May not deliver to a dormitory, hotel, motel, bed and breakfast or any other commercial business.
May not deliver marijuana items to a consumer at any location outside the jurisdiction in which they are licensed. A
retailer is responsible for being familiar with the boundaries of the jurisdiction in which they may deliver marijuana items.
Notwithstanding this prohibition, a retailer with this registration may deliver marijuana items to a patient or a patient’s
designated primary caregiver at an individual’s residence at any location in Oregon.
May not have more than $3000 worth of marijuana items out for delivery at any one time.
Must record a home delivery sales manifest prior to exiting the licensed premises.
Must carry a physical copy of the delivery manifest and the bona fide order for delivery with every in-transit delivery
Must use a motor vehicle, insured at or above the legal requirements in Oregon, capable of locking all doors and
equipped with an alarm system. All marijuana items must be kept in a lock-box securely affixed inside the delivery vehicle.
I WISH TO REGISTER TO DELIVER MARIJUANA ITEMS.
I have read and understand OAR 845-025-
2880, including the requirements summarized above. Additionally, I understand that OAR 845-025-2880(2)(e)
provides that the Commission may withdraw approval for delivery service if the Commission finds that the
retailer is not complying with OAR 845-025-2800, the personal safety of delivery personnel is at risk, the
retailer’s delivery service has been the target of theft, or the delivery service is creating a public safety risk.
Signature:
Date:
Name:
Title:
OLCC USE ONLY
Registration approved by:
Date:
[FORM MJ 17-5205] mj_opt_ret_delivery (revised 20190104) Page 1 of 1
OREGON LIQUOR CONTROL COMMISSION
Supplemental Form:
Retailer Home Delivery Registration
What is this form?
A recreational marijuana retailer may register with the OLCC to deliver marijuana items to a customer at that customer’s
place of residence. Deliveries may only be performed within the same local jurisdiction as the retailer’s licensed premises,
except that a retailer with this registration may deliver marijuana items to a patient or a patient’s designated primary
caregiver at an individual’s residence.
Section 1 – Retailer Information
Application/License ID:
Applicant/Licensee Name:
Contact Name:
Contact Phone:
Contact Email:
Section 2 – Acknowledgements
Registered Retailers:
May deliver marijuana items to a residence between the hours of 8:00 AM and 9:00 PM.
May deliver marijuana items only to a location that is a residence, such as a house or apartment.
May deliver marijuana items only pursuant to a bona fide order.
May not deliver to a dormitory, hotel, motel, bed and breakfast or any other commercial business.
May not deliver marijuana items to a consumer at any location outside the jurisdiction in which they are licensed. A
retailer is responsible for being familiar with the boundaries of the jurisdiction in which they may deliver marijuana items.
Notwithstanding this prohibition, a retailer with this registration may deliver marijuana items to a patient or a patient’s
designated primary caregiver at an individual’s residence at any location in Oregon.
May not have more than $3000 worth of marijuana items out for delivery at any one time.
Must record a home delivery sales manifest prior to exiting the licensed premises.
Must carry a physical copy of the delivery manifest and the bona fide order for delivery with every in-transit delivery
Must use a motor vehicle, insured at or above the legal requirements in Oregon, capable of locking all doors and
equipped with an alarm system. All marijuana items must be kept in a lock-box securely affixed inside the delivery vehicle.
I WISH TO REGISTER TO DELIVER MARIJUANA ITEMS.
I have read and understand OAR 845-025-
2880, including the requirements summarized above. Additionally, I understand that OAR 845-025-2880(2)(e)
provides that the Commission may withdraw approval for delivery service if the Commission finds that the
retailer is not complying with OAR 845-025-2800, the personal safety of delivery personnel is at risk, the
retailer’s delivery service has been the target of theft, or the delivery service is creating a public safety risk.
Signature:
Date:
Name:
Title:
OLCC USE ONLY
Registration approved by:
Date:
[FORM MJ 17-5205] mj_opt_ret_delivery (revised 20190104) Page 1 of 1