Produce Perks Mobile Market Application

Thank you for your interest in Produce Perks.

This form is for mobile markets.
All information provided will be kept confidential. 

A member of the Produce Perks team will follow-up with you within 30 days with additional questions and next steps.

Please do not complete this form if your market already offers Produce Perks.

If you are a farmers' market, please complete this application.
If you are a farm stand or a farm offering direct sales or a CSA, please complete this application.

If you are a grocery store, or other brick and mortar, owner/operator, please review the information for Grocery Stores & Retail Sites and complete the Interest Form, found here

If you are a customer, please use the Market Locater Tool to find the closest market to you that offers the Produce Perks match: 
https://producerperks.org/locations/

Produce Perks Mobile Market Application


Mobile Market Information
Primary Address



Please use the two letter state abbreviation.


Need help finding your market's zip code extension? Visit https://tools.usps.com/zip-code-lookup.htm?byaddress.
Need help finding your market's Zip Code +4?
Visit https://tools.usps.com/zip-code-lookup.htm?byaddress.

Schedule Information


If your market hours change seasonally, please indicate that information here. Ex. May-Oct, 12pm-6pm; Nov-Apr, 2pm-6pm.
When does your location open & close for the year?

If your location is open year-round, enter January 1 as the start date and December 31 as the end date.

If your market is a winter market that opens in the fall and ends in the spring, your start date should be the date of the first market in 2024 and your end date should be the last market of 2024.
Please add notes to the Additional Information box above to clarify.

The start date should be no sooner than 01/01/2024 and the end date should be no later than 12/31/2024.


Mailing Address
This is the address where we should send postal mail.



Please use the two letter state abbreviation.

Shipping Address
This is the address where we should ship program materials.
This cannot be a PO Box.
It should be an address where someone is generally available to sign for a package, or where a signature can be coordinated if needed.



Please use the two letter state abbreviation.

Public Information






Page 3

SNAP Information


This is a 7-digit number printed on the SNAP permit sent to you when you became authorized to participate in SNAP. Please include any leading zeros.



Please refer to your FNS Authorization certificate. This is always an individual - not an organization.



Market Operations











Page 4

Ownership Information

The name of the entity or person on your W9.


Address as it appears on W9



Please use the two letter state abbreviation.

Contacts
Please complete the information for four key contacts. If one individual fills multiple roles, please enter their information in each applicable area.
Primary Program Contact
The Primary Program Contact is the person who will be responsible for program operations if your market is accepted to participate in Produce Perks.





Authorized Official
The Authorized Official is the person who is legally authorized to sign contracts if your market is accepted to participate in Produce Perks.





Financial Contact
The Financial Contact is the person who will be responsible for accounting and invoicing if your market is accepted to participate in Produce Perks.





Produce Perks Farmers' Market Application