Lead Capture Form

Name

Valid Email Address

Phone number

What am I?

Current Operator

License Holder and Future Operator

Dispensary Owner/Operator

License Applicant

Current Operator:

1. Operation

Warehouse

Greenhouse

Hybrid

2. Operational Goals - Please list these operational goals in the order of your priorities:

b. Control Energy Costs

i. Current Electric Charges per month?

1. Name of your Utility providing Electric and Gas services

ii. Current Lighting

1. Veg

HPS (i) Vendor

HID (i) Vendor

LED (i) Vendor

2. Flower

HPS (i) Vendor

HID (i) Vendor

LED (i) Vendor

iii. What is your current Climate Control situation:

Standard

Hybrid

Radiant Cooling

iv. Realestate -

Own

Rent

Square feet

Table top flower square feet

3. Do you have a tax appetite?

Yes

No

FUTURE OPERATORS

2. Do you have your license yet?

Yes

No

3. Do you have realestate already secured?

Yes

If not, do you need assistance locating a property?

4. Financing

a. Do you have a finance source?

Yes

No

b. How much have you budgeted for your operation

5. Do you have equipment preferences?

Yes

No

6. Do you have your distribution channels in place for your final product?

Yes

No

7. Are you interested in extraction and MIPS operations?

Yes

No

8. Do you have your Grow Master on board?

Yes

No

9. Do you have your strain selection?

Based on demand?

Based on quality?

Based on yield?

10. How much money do you want your operation to gross your first year?

Lead Capture Form

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