Farmer on Fire Application

1

What is your name?* This field is required.

First Name

Last Name

2

What is your email?* This field is required.

3

What is your phone number?* This field is required.

Please enter a valid phone number.

4

What is your business revenue?* This field is required.BE HONEST!

$0-100K

$100-250K

$250-500K

$1 million+

5

What is your business take home?* This field is required.BE HONEST!

$0-100K

$100-250K

$250-500K

$1 million+

6

What Generation Farmer are you?* This field is required.How deep are your family roots?

1st Generation

2nd Generation

3rd Generation

4th Generation

5th Generation or higher.

7

What is your current biggest problem?* This field is required.Select ALL that apply.

Lack of Confidence/Certainty

Trusting Myself to Make Decisions

Financial Unstability

Stuck in Negative Stories

Marriage/Relationship Struggles

Stuck around Negative People

8

Briefly describe your farm operation.* This field is required.Provide a DEEP description including acres, crops/livestock produced, family involved, and role in the Operation.

9

What do you fear the most?Select ALL that apply.

Losing the Farm

My Decision Making

Building My Own Thing

Future Regret of Not Taking Action

Uncertainty of the Future

Other

10

Are you willing to INVEST into you, yourself, and your farm?* This field is required.ARE YOU COMMITTED?

YESNO