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Food Application
Food Application
Food Application
Date
*
MM slash DD slash YYYY
Market Category
*
Food Purveyor
Packaged Food
Name
*
First
Last
Company/DBA
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
*
Website
Have you ever exhibited in a market before?
*
Yes
No
List the crops/food items/menu/product you would like to offer:
*
List current market you participate in:
*
Organic Registration? (if applicable)
*
Yes
No
Do you meet all Dept of Health permitting, booth and equipment requirements for food prodcution and/or packaged food. *No sampling at this time.
*
Yes
No
Which of the following do you qualify for or have an existing permit for?
*
Cottage
Commissary
Cart
Booth space request:
*
10x10
20x20
Market Quarters You'd Like to Attend:
*
Spring
Summer
Autumn
Winter
All
Please indicate that you understand submission of information does NOT qualify you for entry into the Harvest Market. The Market Manager will contact you regarding your application.
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