Quote CBD, Hemp & Marijuana 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.* Select All 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?* Select1234More than four Total Annual Projected Sales from all operations to be insured* Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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. 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 No 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 No Location 1 How many buildings are there at location 1? If none select one of the other optiosn SelectNo buildings or structures this is a grow location123 Location 1 Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Describe Location 1 (if building -Age, general location, condition) Location 2 Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Describe Location 2 (if building Age, general location, condition) Location 3 Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Describe Location 3 (if building Age, general location, condition) Location 4 Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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 No Check all that apply General Liability Property Crop Excess Product Liability Name of General Liability Insurance Company Expiration Date Date Format: 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 No Share this:TwitterFacebookLike this:Like Loading... CannabisHempMarijuanaQuote CBDQuote Hemp
