APPLICATION
Print this Application, fill it out, and return it to the address below with your check.
| Name: |
| Mailing Address: |
| City: | State: | Zipcode: |
| Shipping Address | ||
| City: | State: | Zipcode: |
| Phone: | FAX: |
| E-mail: | Website: |
| Farm Name: | Acres in Production: |
| Business Name: | |
| Hours of Operation: | |
| Location of Your Farm: | |
| Farmers Market Affiliation: | |
| Location of Farmers Market or Web Site Address: | |
|
Product
|
Months Available
|
Product
|
Months Available
|
| Method of Production | Certified Organic: ___ | Organic:___ | No Chemicals: ___ |
| Specific instructions to buyers: |
| Directions to your farm if difficult to locate: |
| I certify that the applicant represents a Family Farm* as defined by this program. | |
| Signature: | Printed Name: |
|
Enclose check or M.O. for $30.00 and send it along
with your completed application to:
|
|
P.O. Box 190
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Marionville, MO 65705
|
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(417) 258-2394
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