Producer Interest Form

First Name

Last Name

Website

Facebook Page

Email Address

Cell Phone

Business Name

What type of producer are you? What type of producer are you? Farmer Food Artisan Other

What do you produce on your farm? What do you produce on your farm? Vegetables Fruit Meat Eggs Flowers

What are your fruit, vegetable and/or flower production practices? What are your fruit, vegetable and/or flower production practices? Certified organic Not certified organic, but do NOT us synthetic chemicals Integrated pest management (IPM) Conventional grower

What fruit, vegetables and/or flowers do you grow?

What are your animal production practices? What are your animal production practices? Certified organic Consistent with certified humanely raised Conventional producer

What animals do you raise?

What food do you produce? What food do you produce? Baked goods Ready-to-eat foods Jams Beverages (coffee, tea, etc.) Other

Describe what you would like to bring to market.

If accepted into the Market, I will carry $2 M in liability insurance and have HPFM, LLC as a certificate holder and as an additional insured. If accepted into the Market, I will carry $2 M in liability insurance and have HPFM, LLC as a certificate holder and as an additional insured. Yes No

I participate in other farmers’ markets, sell at other outlets or have a physical store. I participate in other farmers’ markets, sell at other outlets or have a physical store. Yes No

Everything I would like to bring to HPFM I have grown on my farm and/or produced myself. Everything I would like to bring to HPFM I have grown on my farm and/or produced myself. Yes No

I agree to accurately report to HPFM management my gross revenue numbers after each market? I agree to accurately report to HPFM management my gross revenue numbers after each market? Yes No

What else would you like to tell us?