GROWER INFORMATION SHEET 2019

GROWER INFORMATION SHEET 2019
Contact Information
Name of Grower

First NameLast Name
Military Veteran

YesNo
Grower Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Other Partners

First NameLast Name
Military Veteran

YesNo
Farm Name
Owner Name

First NameLast Name
Farm Address

Street Address

Street Address Line 2

CityState / 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 CodePhone Number
Email
example@example.com
How Often Email is Checked

DailySeveral Times During the WeekOnce Per WeekLess Than Once Per WeekRarely
Preferred Means of Contact (Check all that apply)

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

ConventionalCurrently using organic practices, not certified Certified Naturally GrownMAEAP VerifiedCertified 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

Other Crops Not Listed
Additional Information
What experience do you have selling your produce?

NoneSelling retailSelling 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:
Should be Empty:

Contact Information