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Onsite Consumption Application
Onsite Consumption Application
rootscannabis
2020-02-21T17:15:16-05:00
A- Onsite Consumption Application
Applicant's Name:
Mailing Address:
Mailing Address:
Mailing Address:
Mailing Address:
City
City
State/Province
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State/Province
Zip/Postal
Zip/Postal
Website Address:
Email:
Phone No.:
Proposed Effective Date (include any set up and tear down dates):
From
To
12:01 A.M., Standard Time at the address of the Applicant
ANSWER ALL QUESTIONS—IF THEY DO NOT APPLY, INDICATE “NOT APPLICABLE” (N/A)
Applicant is:
Individual
Corporation
Partnership
Joint Venture
Limited Liability Company
Other (Specify):
Other (Specify):
Limits Of Liability and Deductible Requested:
General Aggregate (other than Products/Completed Operations)
$
Products and Completed Operations Aggregate
$
Personal and Advertising Injury (any one person or organization)
$
Each Occurrence
$
Damage To Premises Rented To You (any one premise)
$
Medical Expense (any one person)
$
Other Coverages, Restrictions, and/or Endorsements:
$
Deductible
$
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