Mendocino Renegade
Renewal Application for 2025
Name
*
First Name
Last Name
Farm Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Website
Has there been a change in the number of acres?
*
Yes
No
If so, what is the the new acreage?
Farm Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (if different than farm address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Have there been any significant changes in your operation, for example: vegetables to livestock, or a significant change in practices? If so, please describe the change.
Please upload or attach a plot plan of your facilities or farm IF SIGNIFICANT CHANGES WERE MADE from last year
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Have you added or dropped vegetables or livestock? Please list
If you are scheduled for an inspection this year (i.e., didn't have one last year) or made any significant changes in the off-farm inputs you use, please fill out an Off-Farm Inputs Report using the form provided or attaching your answers to the questions.
Changes in off-farm inputs?
Attach your Off Farm Inputs Report
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Additional information, comments, or questions about anything.
Do you need a Renegade metal sign?
Yes, please send me one
Don't need one
Do you want any brochures to hand out to customers? (If yes, please specify how many.)
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. I have read and understand all standards documents and the materials list.
*
I agree
Date
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Month
-
Day
Year
Date
Signature
*
My Products
*
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Membership Renewal
$
75.00
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Credit Card
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