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Contact
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Cannabis Industry Operations Insurance Application
Legal Business Name
*
Contact Name
*
First
Last
[object Object]
Type of Business
*
Select One
Corporation
Partnership
LLC
Individual
Other
Choose All Operations That Apply
*
Cultivation
Processor
Manufacturer
Cannabis Retail
Lab
Hydroponics Retail
Smoke Shop
delivery Operations
List your projected sales by category for the next 12 months
Cultivation Sales Projections
*
Processing Sales Projections
*
Medicinal Retail Sales Projections
*
List Your Total Sales for last 12 Months
*
If no prior sales enter zero.
Check All that Apply
*
We have Multiple Locations
We have Multiple Operations
We are Currently Uninsured
We've had prior losses or claims
Email
*
Contact Phone
*
If Other Type Business List Here
*
Are you a member of any cannabis trade association?
*
CCSE
NORML - NBN
NCIA
CCIA
Other
Manufacturing Sales Projections
*
Recreational Retail Sales Projections
*
Laboratory & Testing Sales Projections
*
New Ventures - Check All that apply
*
New Venture
Principals have required experience
If you are a new venture, principal must have 1 year of cannabis industry experience.
Your Current Insurance - Choose All that apply
*
General Liability
Property Insurance
Crop Insurance
Excess / Umbrella Coverage
Products Liability
Notes
*
Provide any details about your business below.
Submit
