Become a Supplier

Producer Name (required)

Date questionnaire completed (required)

Farm or Business name

Address

County

Phone

Email (required)

Zip Code

Fax

Farm address (if different from above)

Size of Farm

Size of current production area, in acres or square feet

How long have you farmed there?

Distance from Pittsboro

What products would you like to sell to the co-op? Please check all that apply

 produce (fresh fruits, vegetables, flowers, mushrooms) dairy/egs (cheese, milk, yogurt) Meats (processed, frozen or fresh) Processed goods (baked, jams, jellies, salsas, teas, etc.) Other

If other, please specify

Is your farm certified USDA Organic?

 yes no

If yes, please provide copy of your application for Organic certification. Although it may seem redundant, we would still request that you complete this questionnaire as ist will hellp Chatham Marketplace get to know you better than we could by merely reading your certification application.

When would you be able to begin providing your products to CM?

Employees: What percentage of work (approximately) is done by others than family members?

Are your employees (please check all that apply)

 full time part time seasonal migrant interns

In a sentence or two, would you please describe working conditions for your employees

What soil conservation practices do you use?

What sort of irrigation do you use?

Please list any inspections, licenses or certifications that you do have with expiration dates. (Please supply a copy of any application documents listed.)

Describe any practices or characteristics unique to your farm that you believe add value to what you produce.

Are there any things you want us to know about your farm?