Producer Interest Form
About You
First Name
Last Name
Name of farm, mill, creamery or processor:
Email address:
Phone number:
By providing a telephone number and submitting this form you are consenting to be contacted by SMS text message. Message & data rates may apply. You can reply STOP to opt-out of further messaging.
Where is your farm located?
City
State
Please select...
Alabama - AL
Alaska - AK
Arizona - AZ
Arkansas - AR
California - CA
Colorado - CO
Connecticut - CT
Delaware - DE
Florida - FL
Georgia - GA
Hawaii - HI
Idaho - ID
Illinois - IL
Indiana - IN
Iowa - IA
Kansas - KS
Kentucky - KY
Louisiana - LA
Maine - ME
Maryland - MD
Massachusetts - MA
Michigan - MI
Minnesota - MN
Mississippi - MS
Missouri - MO
Montana - MT
Nebraska - NE
Nevada - NV
New Hampshire - NH
New Jersey - NJ
New Mexico - NM
New York - NY
North Carolina - NC
North Dakota - ND
Ohio - OH
Oklahoma - OK
Oregon - OR
Pennsylvania - PA
Rhode Island - RI
South Carolina - SC
South Dakota - SD
Tennessee - TN
Texas - TX
Utah - UT
Vermont - VT
Virginia - VA
Washington - WA
West Virginia - WV
Wisconsin - WI
Wyoming - WY
About your Operations
What types of products do you offer?
Vegetables
Fruit
Dairy
Meat
Grains
Value added
Other
How would you describe your farm/production practices? (200 words or less)
Do you have any certifications? If so, what?
If you are a produce farmer, are you GAP Certified?
Not applicable
Yes, with up to date documentation
No
GAP Certification in process
Are you able to provide a distributor price list or availability list?
Yes
No
Form Approved by Tatiana Granados 12/1/17
reCAPTCHA helps prevent automated form spam.
The submit button will be disabled until you complete the CAPTCHA.
Contact Information