Cannabis License Application

Formal Business Application for Tribal Cannabis Licensure

Submit complete business information for review by Agency Tribal Nations licensing staff. All fields marked with an asterisk are required.

1. Applicant / Point of Contact

The individual authorized to submit this application on behalf of the business.

First Name *

Last Name *

Email *

Phone *

Title / Role at Business

2. Business Information

Full legal and operational details of the applying business.

Legal Business Name *

DBA / Trade Name

Business Entity Type *

State / Tribal Jurisdiction of Formation

EIN / Federal Tax ID

Date Business Established

Business Phone

Business Website

Number of Employees

Years in Operation

Business Street Address *

City *

State *

ZIP *

Mailing Address (if different)

3. License & Operations

The license being sought and the proposed scope of operations.

License Type Applying For *

Estimated Annual Revenue

Proposed Premises Address (physical location of licensed operation)

GPS Coordinates of Premises (Latitude, Longitude)

Source of Capital / Funding

Description of Proposed Operations

4. Ownership & Compliance History

Ownership structure and regulatory history required for licensing review.

Owner(s) Full Name(s) and Ownership %

Prior Cannabis Licenses Held (any state or tribal jurisdiction)

Has any owner/officer had a license denied, suspended, or revoked?

If yes, please explain

5. Additional Details

Anything else the licensing team should know?

I certify that the information provided in this application is true and accurate to the best of my knowledge, and that I am authorized to submit this application on behalf of the business named above. *