Business Information
Tell us about your cannabis business. Please enter your legal business name and primary contact information.
Business Identity
Mailing Address
Best Contact for Inspection
Licenses & Numbers
Partner Brands / Companies You Own
Additional Insureds to List on Policy
Coverage & Loss History
Answer honestly — this information helps us find the right markets for your account.
Coverage Questions
Prior Coverage History
| Effective Date | Carrier | Limits | Annual Premium |
|---|---|---|---|
Claims History (Last 5 Years)
| Date of Claim | Type of Claim | Amount | Date Paid |
|---|---|---|---|
Operations & Income
Select all operations that apply to your business and provide your revenue breakdown.
What Are Your Operations? *
* Required — select all that apply. Your selections determine which coverage sections follow.
Types of Products Sold *
* Required — select all that apply.
Annual Income by Source
| Source | Current Year | Last Year | Next Year (Projected) |
|---|---|---|---|
| Retail | |||
| Cultivation | |||
| Manufacturing | |||
| Smoke Accessories | |||
| Vape / Tobacco |
Coverage Preferences
Select your desired coverage limits and answer the underwriting questions below.
General Liability
Product Liability
Property & Building Details
Provide details for each location. Add all buildings that need coverage.
Cultivation
Complete this section if you cultivate cannabis. Check N/A if cultivation does not apply to your operation.
Cultivation Type
Lighting Type(s)
Plant Phases
| Phase | # of Plants | Value per Plant ($) | Total ($) |
|---|---|---|---|
| Seedlings | |||
| Vegetative | |||
| Flowering |
Outdoor Grow
Greenhouse
Greenhouse Construction Type
Extraction & Wholesale
Complete applicable sections. Check N/A for any that don't apply.
Extraction
Extraction Methods
Wholesale
Wholesale Products
Manufacturing, Security & Signature
Complete manufacturing details if applicable, then confirm your security measures and sign the application.
Manufacturing
Products Manufactured
Security Measures (Check All That Apply)
★ Central fire alarm is required on most policies.
Applicant Signature
By submitting this application, I certify that the information provided is true and accurate to the best of my knowledge.