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Producer name
Date questionnaire completed
Farm or Business name
Address
County
Phone
Email
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 are the products you would like to sell to the co-op? Please check all that apply.
Produce (fresh fruits, vegetables,flowers,mushrooms)
Dairy/Eggs (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 it will help 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 date. (Please supply a copy of any applicable documents listed.)
Describe any practices or characteristics unique to your farm that you believe add value to what you produce.
Are there any other things you want us to know about your farm?
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