Form FMC-11 "Farmers' Market Nutrition Program (Fmnp) Vendor List" - New York

What Is Form FMC-11?

This is a legal form that was released by the New York State Department of Agriculture and Markets - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 3, 2019;
  • The latest edition provided by the New York State Department of Agriculture and Markets;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form FMC-11 by clicking the link below or browse more documents and templates provided by the New York State Department of Agriculture and Markets.

ADVERTISEMENT
ADVERTISEMENT

Download Form FMC-11 "Farmers' Market Nutrition Program (Fmnp) Vendor List" - New York

543 times
Rate (4.4 / 5) 33 votes
Farmers’ Market Nutrition Program (FMNP)
Rev 1/3/2019
VENDOR LIST (FMC-11)
Clear Form
Instructions: Fill in the information below for every fruit and vegetable vendor anticipated to attend/is currently
attending your market during either the FMNP season (June 1 – November 30) or from your market’s opening
day to your closing day, whichever is the shorter season. The vendor information should be specific to each
market day and location. For example, if your market operates on Tuesday and Thursday, submit a separate
vendor list for each market day. Include both farmers (growers) and dealers. If the vendor is participating or
plans on participating in the FMNP, provide the additional information requested for FMNP farmers; if new to the
FMNP this year, write “new” when asked for the FMNP ID number. Make copies of this form if needed.
Market Name: _____________________________________ Day: ☐Mo ☐Tu ☐We ☐Th ☐Fr ☐Sa ☐Su
How many total vendors participate in the market (e.g. produce, meat, dairy, hot food, craft, etc.): ____
Full-season (e.g. vendor commits to being there every week during FMNP season):
____
Partial-season (e.g. vendor commits to being there select weeks/months during the season):
____
Daily (e.g. vendor has no commitment; might only attend the market one single day per season):
____
Business Name (#1): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
FMNP Eligible Farms:
☐ N/A, this vendor is not eligible for FMNP at this market.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Do you anticipate the vendor will meet the “50% Grow Rule” as defined by the FMNP? ☐Yes ☐No ☐Unknown
Business Name (#2): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
FMNP Eligible Farmers:
☐ N/A, this vendor is not eligible for FMNP at this market.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Do you anticipate the vendor will meet the “50% Grow Rule” as defined by the FMNP? ☐Yes ☐No ☐Unknown
Signature of Applicant. I acknowledge that I have read and agree to abide by the NYS FMNP “Rules and
Procedures for Markets (FMC-4)” provided by the NYS Department of Agriculture and Markets. By signing
below, I certify that all information is true and correct to the best of my knowledge.
Signature (required): ______________________________________________________ Date: __________
Print Name: ______________________________________________Title: ___________________________
Submit to:
NYS Dept. of Agriculture and Markets Attention: FMNP
Fax: (518) 457-8398
10B Airline Drive Albany NY 12235
Email:
farmersmarkets@agriculture.ny.gov
Questions?
Albany: (518) 457-7076 prompt #1
Toll Free: (800) 554-4501
This institution is an equal opportunity provider.
Farmers’ Market Nutrition Program (FMNP)
Rev 1/3/2019
VENDOR LIST (FMC-11)
Clear Form
Instructions: Fill in the information below for every fruit and vegetable vendor anticipated to attend/is currently
attending your market during either the FMNP season (June 1 – November 30) or from your market’s opening
day to your closing day, whichever is the shorter season. The vendor information should be specific to each
market day and location. For example, if your market operates on Tuesday and Thursday, submit a separate
vendor list for each market day. Include both farmers (growers) and dealers. If the vendor is participating or
plans on participating in the FMNP, provide the additional information requested for FMNP farmers; if new to the
FMNP this year, write “new” when asked for the FMNP ID number. Make copies of this form if needed.
Market Name: _____________________________________ Day: ☐Mo ☐Tu ☐We ☐Th ☐Fr ☐Sa ☐Su
How many total vendors participate in the market (e.g. produce, meat, dairy, hot food, craft, etc.): ____
Full-season (e.g. vendor commits to being there every week during FMNP season):
____
Partial-season (e.g. vendor commits to being there select weeks/months during the season):
____
Daily (e.g. vendor has no commitment; might only attend the market one single day per season):
____
Business Name (#1): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
FMNP Eligible Farms:
☐ N/A, this vendor is not eligible for FMNP at this market.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Do you anticipate the vendor will meet the “50% Grow Rule” as defined by the FMNP? ☐Yes ☐No ☐Unknown
Business Name (#2): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
FMNP Eligible Farmers:
☐ N/A, this vendor is not eligible for FMNP at this market.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Do you anticipate the vendor will meet the “50% Grow Rule” as defined by the FMNP? ☐Yes ☐No ☐Unknown
Signature of Applicant. I acknowledge that I have read and agree to abide by the NYS FMNP “Rules and
Procedures for Markets (FMC-4)” provided by the NYS Department of Agriculture and Markets. By signing
below, I certify that all information is true and correct to the best of my knowledge.
Signature (required): ______________________________________________________ Date: __________
Print Name: ______________________________________________Title: ___________________________
Submit to:
NYS Dept. of Agriculture and Markets Attention: FMNP
Fax: (518) 457-8398
10B Airline Drive Albany NY 12235
Email:
farmersmarkets@agriculture.ny.gov
Questions?
Albany: (518) 457-7076 prompt #1
Toll Free: (800) 554-4501
This institution is an equal opportunity provider.
Farmers’ Market Nutrition Program (FMNP)
Rev 1/3/2019
VENDOR LIST (FMC-11)
Business Name (#3): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
FMNP Eligible Farms:
☐ N/A, this vendor is not eligible for FMNP at this market.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Do you anticipate the vendor will meet the “50% Grow Rule” as defined by the FMNP? ☐Yes ☐No ☐Unknown
Business Name (#4): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
FMNP Eligible Farms:
☐ N/A, this vendor is not eligible for FMNP at this market.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Do you anticipate the vendor will meet the “50% Grow Rule” as defined by the FMNP? ☐Yes ☐No ☐Unknown
Business Name (#5): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
FMNP Eligible Farms:
☐ N/A, this vendor is not eligible for FMNP at this market.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Do you anticipate the vendor will meet the “50% Grow Rule” as defined by the FMNP? ☐Yes ☐No ☐Unknown
Business Name (#6): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
FMNP Eligible Farms:
☐ N/A, this vendor is not eligible for FMNP at this market.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Do you anticipate the vendor will meet the “50% Grow Rule” as defined by the FMNP? ☐Yes ☐No ☐Unknown
Business Name (#7): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
FMNP Eligible Farms:
☐ N/A, this vendor is not eligible for FMNP.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Do you anticipate the vendor will meet the “50% Grow Rule” as defined by the FMNP? ☐Yes ☐No ☐Unknown
This institution is an equal opportunity provider.
Page of 2