GROWER INFORMATION SHEET 2019

GROWER INFORMATION SHEET 2019
Contact Information
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	Country

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	Country

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
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
Describe or list what is used for the following on your farm
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
CROPS TO SELL TO FLINT FRESH
Crops
Leafy Greens

	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
Alliums

	List Months of Harvest
Garlic
Garlic Scapes
Green Garlic
Leek
Onion, Green
Onion, Specialty
Onion, Storage
Shallots

Other Crops Not Listed
Legumes

	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
Tubers/Roots

	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
Brassica/Cruciferous

	List Months of Harvest
Broccoli
Brussels Sprouts
Cabbage
Cauliflower

Other Crops Not Listed
Summer Fruits (if heirloom tomatoes, add *)

	List Months of Harvest
Eggplant
Okra
Pepper, Hot
Pepper, Sweet
Tomato, Cherry
Tomato, Green
Tomato, Paste
Tomato, Slicer

Other Crops Not Listed
Curcurbits

	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
Fruit Tree/Berry

	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
Herbs

	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
Perennial Veggies

	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:
Signature:
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