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Cannabis Industry Operations Insurance Application
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Indicates required field
Legal Business Name
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Contact Name
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First
Last
[object Object]
Type of Business
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Select One
Corporation
Partnership
LLC
Individual
Other
Choose All Operations That Apply
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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
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Processing Sales Projections
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Medicinal Retail Sales Projections
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List Your Total Sales for last 12 Months
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If no prior sales enter zero.
Check All that Apply
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We have Multiple Locations
We have Multiple Operations
We are Currently Uninsured
We've had prior losses or claims
Email
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Contact Phone
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If Other Type Business List Here
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Are you a member of any cannabis trade association?
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CCSE
NORML - NBN
NCIA
CCIA
Other
Manufacturing Sales Projections
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Recreational Retail Sales Projections
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Laboratory & Testing Sales Projections
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New Ventures - Check All that apply
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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
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General Liability
Property Insurance
Crop Insurance
Excess / Umbrella Coverage
Products Liability
Notes
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Provide any details about your business below.
Submit