2024 Application Form - Mendocino Renegade

Name

First NameLast Name

Farm Name

Email

example@example.com

Website

Phone Number

Please enter a valid phone number.

Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How many acres do you farm?

Please describe your operation (i.e vegetables and livestock)

Please list which crops and/or livestock you will be selling

How many years have you been at this location?

Do you own or lease?

Name of Property Owner if leasing

How many years have you farmed or processed using organic standards?

Do you have any prior certification?

YesNo

Who was the Certifier? Which Years?

Please attach a plot plan of your facilities or farm

Statement of organic practices

Please describe your over-arching goals. Why are you growing food? Examples: Feed hungry people, build healthy soil...

Upon acceptance of your application, you will be asked to submit a list of Off-Farm Inputs, with an explanation of any that do not meet our standards. We will schedule an inspection. At that time, you can discuss with us your inputs and practices and how you meet Renegade Principles overall.

I understand that I am solely responsible and liable for any illness or problems resulting from my products sold to consumers, regardless of whether they are certified Mendocino Renegade or not. I understand that the information provided in this applications is accurate and true. Furthermore, I understand that any misrepresentation of the farm or business described herein will be grounds for denying my application and/or removing my farm or business from the Mendocino Renegade certification program. *

Additional information, comments, or questions about anything.

Certification Affidavit: I certify that the information provided in this application is accurate and true. Furthermore, I understand that any misrepresentation of the farm or business described herein will be grounds for denying my application and/or removing my farm or business from the Mendocino Renegade Eco-Label program. I have read and understand all standards documents and the materials list.

Signature*

Fee waivers may be available, please write to mendocinoorganicnetwork@gmail.com with your request. If you prefer (or if this doesn't work!), you may send us a check, written to Mendocino Organic Network, PO Box 182, Willits CA 95490.

New ApplicationFirst Year Certification

$150.00 Quantity

Product Name

$ Free Quantity

Enter coupon

Total

$0.00

Credit Card