Kratom Addiction Testimonial

Name *

Email Address: *

Phone Number *

Address: *

City: *

State: *

ZIP: *

How did you send us your video? *

	you must have at least one item
Uploaded to YouTube	you must have at least one item
Emailed it to JohnBush512	you must have at least one item
Sent Via WeTransfer.com	you must have at least one item
I'm in Austin and want to record in person	you must have at least one item

If uploaded to YouTube, please paste link to video below: *

What type of kratom would you like for your free half ounce? *

	you must have at least one item
Maeng Da (green - versatile)	you must have at least one item
OG Bali (red - pain, relaxation)	you must have at least one item