Marijuana Insurance | Athena Insurance and Financial Services

Thank you for your interest.

Business Name*

Name of "DBA" if applicable

Name of Person completing this form "if different from the owner"*

Phone*

Email*

Enter Email Confirm Email

Check all operations that apply*

Cultivation

Processor

Manufacturer

Cannabis Retail

Lab

Hydroponics Retail

Smoke Shop

Any edibles? "including capsules, juices and other ingestibles)

Delivery Operations

Vape or vape equipment

Other (describe)

Type of business entity*

Corporation

Partnership

LLC

Non-Profit

Not for profit

For Profit

Individual

Other

Proprietorship

Please tick all check boxes for the types of insurance you are interesting purchasing.*

CBD Sales Wholesale

CBD Sales Retail

Hemp Grower

General Liability

Business Property Coverage

Property Building Coverage

Workers Compensation

Business/Commercial Auto

Inventory / stock

Cargo Coverage

How many locations are to be insured?*

Total Annual Projected Sales from all operations to be insured*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Please provide a list of products that you will be distributing or preparing*

Upload product list if you have it in a pdf, jpg or gif format. You may also email the list to insurance@athenainsurance.com

Drop files here or

Accepted file types: jpg, gif, pdf, Max. file size: 128 MB, Max. files: 5.

Section 1 - General Information

Please provide us with a narrative, in detail, regarding your "current" operations as they will be provided for the next 12 months.*

Trade Associations

Are you a member of any cannabis trade associations?

Yes

Are you a member of any of the following cannabis trade associations?

CCSE

NORML

NBN

NCIA

CCIA

Other (describe)

describe other cannabis trade association

List your projected sales/donations by category for the next 12 months

If it does not apply to you type in "n/a" please.

New Venture No prior sales

No prior sales

a. Cultivation sales/donations

b. Manufacturing sales/donations

c. Processing sales/donations

d. Recreational retails sales

e. Medicinal retail sales/donations

f. Laboratory and testing sales/donations

g. Other

Total projected next 12 months sales/donations

If new venture: Do any of the principles have a minimum of 1 year in the cannabis industry?*

Yes

Location 1

How many buildings are there at location 1? If none select one of the other optiosn

Location 1

Street Address City State ZIP Code

Describe Location 1 (if building -Age, general location, condition)

Location 2

Street Address City State ZIP Code

Describe Location 2 (if building Age, general location, condition)

Location 3

Street Address City State ZIP Code

Describe Location 3 (if building Age, general location, condition)

Location 4

Street Address City State ZIP Code

Describe Location 4 (if building Age, general location, condition)

1. How do you prevent the distribution of product to minors?*

History

All questions must be answered. Failure to disclose proper history could invalidate and and all coverage.

2. Do You currently have any commercial insurance coverage for this operation?

Yes

Check all that apply

General Liability

Property

Crop

Excess

Product Liability

Name of General Liability Insurance Company

Expiration Date

MM slash DD slash YYYY

General Liability

What limits of liability are you looking to acquire?

Business Personal Property

What limit on BPP are you needing. Things such as computers,furniture (stock and inventory limit disclose below)

Stock and Inventory Coverage

Please list inventory / stock cover if desired. Please note the location(s) that the coverage applies to as well.*

Cargo Coverage

Optional Promotion of your Business

Are you interested in receiving at least one year of free advertising on https://CannabisPeeps.com? (not purchase required)*

Yes

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Hemp, CBD & Marijuana Insurance

Thank you for your interest.

Section 1 - General Information

Trade Associations

List your projected sales/donations by category for the next 12 months

Location 1

History

General Liability

Business Personal Property

Stock and Inventory Coverage

Cargo Coverage

Optional Promotion of your Business