Applicant Name(required) DBA Address Email(required) Are you a member of any cannabis / marijuana trade associations, If yes what organizations Description of Product use, recreational, medicinal or both Description of operations List of subsidiaries List any additional offices and provide locations Have any of the principals engaged in this or similar enterprises under a different name? If yes, please list entity and operations Provide business financial information for the last five years and estimates for next year for Domestic Sales, Foreign Sales, Payroll and # of employees Physical Address Operating (If more than one location download multiple location supplemental and email to info@greenrockins.com) What are the operations at this location (manufacturer, processor, indoor grower, outdoor grow, retail, dispensary, lab, delivery or other (describe) Is there any oil extraction done at this location. If yes, what method is used? (CO2, Butane, Propane, etc..) Sq footage Describe alarm systems, and fire control such as sprinklers annunciator panel etc I own this building Describe any repairs, construction, renovations along with estimated date of completion and investment value Approved safe (minimum safe requirements: 800 lb with a 1-hour fire rating under 2,000 lb must be bolted to the ground Is there a vacuum oven, centrifuge, distillation column and / or Roto Vaps in the building. If yes, please provide manufacturer, model number, replacement cost and motor's HP for each Gross Sales Cost of Sales less Payroll Business Personal Property - Replacement Cost Indoor Grow Equipment - Replacement Cost Tenant Building Improvements - Customization Replacement Cost Completed Stock - Value of manufactured products ready for sale or packages and sealed inventory containing marijuana buds and / or its derivatives. No harvested or growing plants fall under this category Goods in Process - Value of Cannabis Buds and Flowers that have been harvested and are in the curing phase of production. No stock, crop or growing plants fall under this category Number of Seeds and value basis Immature Seedlings # and per plant value you wish to use Vegetative Plants # and per plant value you wish to use Flowering Plants # and per plant value you wish to use Harvested Plants # and per plant value you wish to use Annual gross receipts from medical marijuana (i.e. leaves, bud, flower and trim) previous 12 months Projected next 12 months Annual gross receipts from infused medical marijuana edible products containing THC or other active cannabinoids (e.g. baked goods, candies, other food or drink items, tinctures, capsules etc Projected next 12 months Annual gross receipts from topical medical marijuana products containing THC or other active cannabinoids (e.g. oils, creams, lotions) Projected next 12 months Annual gross receipts from medical marijuana oil cartridges or medical marijuana concentrates intended for use in vaporizing devices Projected next 12 months Total Sales Medical Marijuana Products & Projected next 12 months Submit Δ Share this:TwitterFacebookLike this:Like Loading...
GreenRock-Insurance brokerage 