849 International Drive, 4th Floor, Linthicum, MD, 21090, US
What Type of Third Party Business Are You Registering?
Please Provide Your Business Name(s)
What Type of Business Structure Do You Have?
IS YOUR PHYSICAL ADDRESS THE SAME AS YOUR MAILING ADDRESS?
Additional Point-of-Contact (If Applicable)
Date of Incorporation/Formation
Is this Business registered in Maryland?
Please provide your status of Good Standing (from the Maryland Department of Assessments and Taxation - MD SDAT).
Has the Business or any of its partners, members, managers, officers, stockholders, or directors:
Has a cannabis license or registration ever been issued to the Business or any of its partners, members, managers, officers, stockholders, or directors?
Does the Business have legal control of the premises by virtue of:
Please upload a diagram of the premises to be registered and outline or designate the area (including dimensions) which shows the registered premises limited access areas, walls, partitions, entrances, exits and what each room shall be utilized for in this business. In a separate diagram, include security equipment locations. These diagrams should be no larger than 8 1/2" X 11". (They do not have to be to scale.)
Please upload a diagram of the premises including the designated LIMITED access areas, walls, partitions, entrances, and exit locations (provide dimensions). Also, please provide information about how each room will be utilized.
Please upload a diagram of the premises including the designated security equipment areas.
Please upload all notes, security instruments, written agreements, and/or details of verbal agreements by which any person, firm, partnership, corporation, limited liability company, or trust will share in the profit or gross proceeds of this business.
Please upload any agreement that is conditionally or contingently related to this business by way of volume, profit, sales, advices, or consultation.
Other than those listed above, is there any other person, supplier, lender, landlord, etc. who will directly or indirectly receive compensation or rents based upon a percentage or share of gross proceeds or income of the registrant’s business?
Has the business, a parent company, or any other intermediary business entity ever applied for a cannabis license or registration in any state or country? (regardless of whether or not the license or registration was ever issued)
Has the business, a parent company, or any other intermediary business entity ever owned a cannabis license or registration in any state or country?
Was the business, a parent company, or any other intermediary business entity who owned a cannabis license or registration, ever subject to any of the following actions?
Has the business, a subsidiary, or a principal employee, director, principals, officer, owner, investor, trustee, agent, or partner (of 5% or greater) ever been subject to any of the following actions in any criminal proceeding in this state or any other jurisdiction?
Is the applicant, the applicant’s parent company or any other intermediary business entity delinquent in the payment of any judgments, taxes, interest, or penalties due in any jurisdiction?
Have any of the following federal/state/foreign trust or security law or regulation violations ever been filed or entered against the business, parent company, or intermediary business entity?
UPLOAD REQUIRED: Please provide any documents to prove settlement of these issues. (Include any items currently under formal dispute or legal appeal.)
In the past five (5) years, has the business, parent company, or intermediary business entity been a party to a lawsuit in this or any other state/federal/foreign jurisdiction?
In the past two (2) years, has the business, parent company, or intermediary business entity filed a business tax return?
In the past two (2) years, has the business, parent company, or intermediary business entity completed audited or unaudited financial statements?
UPLOAD REQUIRED: Please provide all financial statements completed in the past two (2) years.
UPLOAD REQUIRED: Please upload a list of the business' operating and investment accounts. (For each account, please include the name of the institution, the address, phone, and account number.)
UPLOAD REQUIRED: Please upload a list detailing each outstanding loan and financial obligation obtained for use in this business. (For each, please include the name of the creditor, the address, phone, loan number, terms, date acquired, due date, and payment history.)
Please provide a detailed plan for how the business will operate long-term. Business plan should include the following:
Please provide a completed copy of Appendix A: Independent Testing Laboratory (Available for download on our website.) as well as a curriculum vitae (CV) for each employees listed in this application.
Please provide a completed copy of Appendix B: Security Guard Agency (Available for download on our website.)
Signature of Authorized Representative