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1
General
2
Financials (Optional)
3
License & Compliance (Optional)
Application Date
*
MM slash DD slash YYYY
What Kind of Company?
*
Cannabis Company
Cannabis Brand
CBD/Hemp Company
Ancillary Company
Licensed Entity
*
DBA
*
Mailing Address
*
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Mobile
Email
*
Metrc API
PHASE I: Background Information & Initial Screen
Officer #1
Officer #2
Title
*
Title
Full Name
*
Full Name
Date of Birth
*
MM slash DD slash YYYY
Date of Birth
MM slash DD slash YYYY
City
*
City
State
*
State
Zip Code
*
Zip Code
Bank Account #1
Bank Account #2
Name of Banking Institution
*
Name of Banking Institution
Account Open Since
*
MM slash DD slash YYYY
Account Open Since
MM slash DD slash YYYY
Hemp/CBD Compliant?
*
Yes
No
Hemp/CBD Compliant?
Yes
No
Cannabis Compliant?
*
Yes
No
Cannabis Compliant?
Yes
No
Are there any tax liens, judgments, or suits pending against the company?
*
Yes
No
Does the company have any debt?
*
Yes
No
Please provide loan documents.
*
Drop files here or
Select files
Max. file size: 50 MB.
Please provide your revenue for the last:
Month (June 2021)
*
Quarter (April - June 2021)
*
Year (June 2020 - June 2021)
*
Please provide the amounts for the following line items from your most recent Balance Sheet:
Bank Deposits
*
Current A/R
*
Inventory
*
PHASE II: Financials (Optional)
Optional - these items will be required during underwriting. Please feel free to attach now in order to expedite our due diligence or continue on to submit without these supporting documents for an initial review.
Please provide an org chart noting all entities
Max. file size: 50 MB.
Please provide the following financial reports (xls format preferred):
Quarterly Balance Sheet as of:
12/31/2020
3/31/2021
6/30/2021
Drop files here or
Select files
Max. file size: 50 MB.
Quarterly Income Statement as of:
Oct-Dec 2020
Jan-Mar 2021
Apr-June 2021
Drop files here or
Select files
Max. file size: 50 MB.
Quarterly A/R Detailed Aging Report as of:
12/31/2020
3/31/2021
6/30/2021
Drop files here or
Select files
Max. file size: 50 MB.
Quarterly A/P Aging Summary Report as of:
12/31/2020
3/31/2021
6/30/2021
Drop files here or
Select files
Max. file size: 50 MB.
Quarterly Metrc “Transfer Report” as of:
12/31/2020
3/31/2021
6/30/2021
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Select files
Max. file size: 50 MB.
Bank statements as of the end of the last financial period provided (ie: if Q1 2021 financials are provided then send bank statement as of 3/31/21)
Drop files here or
Select files
Max. file size: 50 MB.
PHASE III: License & Compliance Review (Optional)
Optional - these items will be required during underwriting. Please feel free to attach now in order to expedite our due diligence or continue on to submit without these supporting documents for an initial review.
Please provide the following information at your earliest convenience as these items may be requested by Bespoke prior to a formal proposal:
Org chart noting all entities
Drop files here or
Select files
Max. file size: 50 MB.
Proof from all states and local hemp licenses and permits
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Select files
Max. file size: 50 MB.
Cannabis licenses and permits held by applicant entity and all related entities
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Select files
Max. file size: 50 MB.
Copies of all insurance policies held (general liability, product, workman’s comp, etc.)
Drop files here or
Select files
Max. file size: 50 MB.
Federal Tax Filings
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Select files
Max. file size: 50 MB.
Federal/State/City tax filings
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Select files
Max. file size: 50 MB.
Cannabis Tax Receipts for payments made to CDTFA (2 most recent quarters)
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Select files
Max. file size: 50 MB.