Language
English (US)
Spanish (Latin America)
Non-Agricultural Farmers Market Fee Form
Total Fees Calculation and Signing
Producer Name
*
Date
*
-
Month
-
Day
Year
Date
Are You an Advertiser?
*
Yes
No
Items Bought and Sold
Rows
Items
Amt. Brought
Amt. Sold
+
+
+
+
+
+
+
+
+
+
Amount Paid With EBT / Food Stamps
Rows
Total Amount $
EBT / Food Stamps
Total Sale Amount
*
$ Dollar Amount
Advertiser Fee +$50.00
Subtotal Fees Due
*
Total Sale Amount x .15 (or $30 under $300)
State Fee +$2.00
*
Facility Fee +$3.00
*
Total Fee Due $
*
Minus (EBT / Food Stamps) if not Advertiser
Choose a Payment Option
*
Cash
Signature
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Continue
Continue
Should be Empty: