2018 Farmers Agreement Form - Alabama

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F
M
ARMERS
ARKET
N
P
UTRITION
ROGRAM
F
A
ARMERS
GREEMENT
(Valid January 1, 2018 through December 31, 2018)
____________________
Farmer’s Name (Please print)
County of Residence
Stamp # (FMNP ID #)
I understand and hereby agree to abide by the Rules and Procedures as printed on the reverse
side of this form and in the Farmers Market Nutrition Program Training Manual or amendments to
rules that may be promulgated at markets and/or mailed to me. In compliance with USDA’s
regulations, I acknowledge that I have received training by submitting this completed form
and a current year’s growers permit each year to the Farmers Market Authority. I understand
and agree that it is my responsibility to submit these forms.
______________________________
Farmer’s Signature
Today’s Date
Race:
Mailing Address
American Indian or Alaska Native
Asian
Black or African American
Mailing Address City/State/Zip Code
Native Hawaiian or Other Pacific Islander
White or Caucasian
Farm Name
Ethnicity:
Hispanic
Non-Hispanic
Farm Address/City/State/Zip Code
Telephone Number (including area code)
________________________________________________
E-mail Address
Markets You Currently Attend:
FMNP Authorized Market Name
FMNP Authorized Market Name
FMNP Authorized Market Name
FMNP Authorized Market Name
FMNP Authorized Market Name
FMNP Authorized Market Name
Please notify the Farmers Market Authority at 1-877-774-9519 or 334-240-7247 if any of the above information changes.

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