GROWER INFORMATION SHEET 2019

Name of Grower

First Name Last Name

Military Veteran

Yes No

Grower Home Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Other Partners

First Name Last Name

Military Veteran

Yes No

Farm Name

Owner Name

First Name Last Name

Farm Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Acres in Production

Number of Years Farming at This Address

Number of Years Farming at Another Address

List Farm Facebook Page/Instagram/Website

Phone Number

Area Code Phone Number

Email

example@example.com

How Often Email is Checked

Daily Several Times During the Week Once Per Week Less Than Once Per Week Rarely

Preferred Means of Contact (Check all that apply)

Phone Text Email

GROWING PRACTICES & FOOD SAFETY (Please Select all that Apply)

Conventional Currently using organic practices, not certified Certified Naturally Grown MAEAP Verified Certified Organic (name of certifier) Certified Naturally Grown

Fertilizer

Weed Control

Pest Control

Field Preparation Before Planting

Field Preparation After Harvesting

Irrigation

Season Extension Methods

Post-Harvest Cooling/Refrigeration

Food Safety Training/Certificates

List Months of Harvest

Arugula

Asian Greens

Chard

Collard

Kale, Green Curly

Kale, Green Flat

Kale, Red Curly

Kale, Tuscan/Dino

Lettuce, Leaf

Lettuce, Head

Microgreens

Mustard Greens

Salad Mix

Spinach, Baby

Spinach, Large

Turnip Greens

Other Crops Not Listed

List Months of Harvest

Garlic

Garlic Scapes

Green Garlic

Leek

Onion, Green

Onion, Specialty

Onion, Storage

Shallots

Other Crops Not Listed

List Months of Harvest

Beans, Dry

Beans, Green

Beans, Long/Pole

Cowpeas

Peas, Blk-Eyed

Peas, Shelling

Peas, Snap

Peas, Snow

Other Crops Not Listed

List Months of Harvest

Beets

Carrots

Celeriac

Kolrahbi

Parsnips

Potatoes

Potatoes, Fingerling

Radishes

Radish, Fr Brkfst

Rutabaga

Sweet Potato

Turnip

Turnip, Hakurei

Other Crops Not Listed

List Months of Harvest

Broccoli

Brussels Sprouts

Cabbage

Cauliflower

Other Crops Not Listed

List Months of Harvest

Eggplant

Okra

Pepper, Hot

Pepper, Sweet

Tomato, Cherry

Tomato, Green

Tomato, Paste

Tomato, Slicer

Other Crops Not Listed

List Months of Harvest

Cucumber, English

Cucumber, Pickling

Cucumber, Regular

Acorn Squash

Buttercup Squash

Butternut Squash

Delicata Squash

Spaghetti Squash

Sweet Dumpling

Wintersweet

Green Zucc - round

Green Zucc -reg

Yellow Zucc-round

Yellow Zucc - reg

Patty Pan

Yellow Summer Squash

Other Crops Not Listed

List Months of Harvest

Apple

Apricot

Blackberry

Blueberry

Cherry

Currant

Gooseberry

Huckleberry

Melon, Cantaloupe

Melon, Honeydew

Melon, Water large

Melon, Water small

Mulberry

Nectarine

Paw Paw

Peach

Pear

Plum

Raspberry

Strawberry

Other Crops Not Listed

List Months of Harvest

Basil, Lemon

Basil, Thai

Chives

Cilantro

Dill

Marjoram

Mint

Oregano

Parsley, Curly

Parsley, Flat

Rosemary

Sage

Stevia

Tarragon

Thyme

Other Crops Not Listed

List Months of Harvest

Asparagus

Rhubarb

Sunchokes

Other Crops Not Listed

Additional Information

What experience do you have selling your produce?

None Selling retail Selling wholesale

Customers (stores, restaurants, businesses, etc.) to whom you are currently selling your produce:

Customers (stores, restaurants, businesses, etc.) to whom you sold your produce in the past:

Flint Fresh Policy Agreement

I/we agree not to "sell around" Flint Fresh to their existing customers and to help the hub provide a consistency of supply and customer interaction.

I/we understand this policy does not apply to our current customers to whom we were already selling before partnering with Flint Fresh.

Signature:

GROWER INFORMATION SHEET 2019

Contact Information

GROWING PRACTICES & FOOD SAFETY

Describe or list what is used for the following on your farm

CROPS TO SELL TO FLINT FRESH

Crops

Leafy Greens

Alliums

Legumes

Tubers/Roots

Brassica/Cruciferous

Summer Fruits (if heirloom tomatoes, add *)

Curcurbits

Fruit Tree/Berry

Herbs

Perennial Veggies