Primary Contact
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First Name
Middle Name
Last Name
Secondary Contact
First Name
Middle Name
Last Name
Mailing Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Email
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Confirmation Email
Primary Contact Social Security #
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Used for IRS 1098's (Interest deductions)
Secondary Email
example@example.com
Primary Phone Number
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-
Area Code
Phone Number
Secondary Phone Number
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Area Code
Phone Number
Choose your Farm Location
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Bramlett Farms
Syrup Mill Farms
Springfield Farms
Edwards Farms
Eli Knob Farms
Bethany Church Farms
Sandy Creek Lane
Herds Creek Rd
Shady Farms
Siloam Farms
My Farm Location is not listed
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C
1
1-B
2
2-B
3
3-B
4
4-B
5
5-B
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