NYS Cannabis Insurance

Simple. Fast. Covered.

Don’t like the phone? Click here to fill out the application yourself. Save yourself time and back and forth!

If you want someone to call you, fill out this contact form and we will reach out and fill out your application with you. We do not sell your information- someone directly with our office will contact you.

SECTION 1: ACCOUNT INFORMATION

Legal Business Name:
DBA (if applicable):
Mailing Address:
City:
State:
Zip Code:
Physical address (If different:)

City:
State:
Zip Code:

Enterprise Type:
☐ Corporation ☐ LLC ☐ Partnership ☐ Sole Proprietor ☐ Other (Specify): ______

Years in Business:
☐ New Venture (If yes, do principals have at least 1 year of experience in the industry?) ☐ Yes ☐ No

Operations Type (Check all that apply):
☐ Cultivation ☐ Processor ☐ Retail (Cannabis) ☐ Retail (CBD) ☐ Manufacturer ☐ Wholesale
☐ Distribution ☐ Transportation ☐ Delivery Operations ☐ Smoke Shop ☐ Retail - Hydroponics ☐ Lab ☐ Other: ______

Highest Projected Sales Operation: ______

Trade Association Membership:
☐ Yes ☐ No (If yes, select) ☐ NCIA ☐ CCIA ☐ CCSE ☐ NORML ☐ Other: _____