Cannabis Business Supplemental Questionnaire

By submitting the following form, you understand and agree that the information you transmit through the forms is true and accurate. Emerge Law Group cannot guarantee you legal representation and cannot guarantee you any particular result. Importantly, you are not legally represented by Emerge Law Group unless you sign an engagement letter with us in the future.*
- I agree

Please complete the information below for yourself and all equity owners of the business who own 10% or more of the business. We require this information to properly advise your cannabis business with respect to compliance with Oregon law. All information that you provide us through this form will be kept confidential, subject to applicable laws and the Oregon Rules of Professional Conduct, which govern the confidentiality of information we receive from prospective clients like you.
First Name*
Middle Name
Last Name*
Date of Birth*
Month
Day
Year
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Current State of Residency*
Driver's License Number*
State where issued*
All states you have lived in during the last 10 years*
Do you have any criminal convictions?*
- Yes
- No
Please describe your criminal convictions, including year, location and offense*
Do you have any arrests or citations that have not been resolved?*
- Yes
- No
Please describe any unresolved arrests or citations*
Are you married or have a domestic partner?*
- Yes
- No
Spouse's or domestic partner's full legal name*
States operated in (list all)*
Licenses applied for:*
Licenses received:*
License holder entity name(s):*
Where is the location of your existing or proposed business? Have you already purchased or leased the premises for your business?*
Let us know anything else that you believe is relevant to this matter