Cannabis Insurance Application About You / Your BusinessLegal Name:*Legal Entity:*IndividualLLCCorporationPartnershipOtherPrimary Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone:*Email:* Key Contact Name:* First Last Years of Industry Experience:*Description of Operations:*Gross Annual Income:*Hours of Operations:*Have you had any prior insurance?:*YesNoHave you had any claims in the past 3 years?:*YesNoLocation InformationAddress:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Square Footage:*Total Value of Business Personal Property:*computers, desks, etc.Do you own the building?:*YesNoIs the building sprinklered?:*YesNoIs there a security alarm?:*YesNoDescription of security measures on premises:*EmployeesWould you like a quote for Workers Compensation?:*YesNoCoverageCoverage Start Date:* Date Format: MM slash DD slash YYYY Are you in the business of growing cannabis?:*YesNoAre you in the business of dispensing cannabis?:*YesNoWhat is the total value of the premises build out? (estimated total):*What is the total value of your grow equipment? (estimated total):*What is the total value of finished product on premises? (estimated total):*What is the total value of harvested plant material? (estimated total):*What is the total value of living plants? (estimated total):*Total number of vegetative plants? (estimate):*Total number of flowering plants? (estimate):*Total number of harvested plants? (estimate):*Would you like a quote for Employee Benefits? i.e. group health, disability, life insurance:*YesNoHow did you hear about us?:*GoogleReferralYelpOtherWho referred you?:*How?:CAPTCHA