Form FMC-6 "Farmer Participation Agreement" - New York

What Is Form FMC-6?

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 1, 2020;
  • 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-6 by clicking the link below or browse more documents and templates provided by the New York State Department of Agriculture and Markets.

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Download Form FMC-6 "Farmer Participation Agreement" - New York

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Rev 1/2020
Farmers’ Market Nutrition Program (FMNP)
FARMER PARTICIPATION AGREEMENT (FMC-6)
CLEAR FORM
Stamp in the box below using the official FMNP stamp issued to you last year or the last year you participated:
Or: I lost my stamp and I need a replacement stamp (check here):
Or: this is my first year participating in the program (check here):
Interactive training is mandatory for farmers new to the FMNP.
If you are new to the FMNP, please indicate your training status:
I trained on this date: _________ or
I plan on training or
N/A, I am not new to the FMNP; I read the rules.
Does your farm have its own EBT card reader to use on the farm and/or at market?
No
Yes
In-Progress
If yes, do you use this EBT card reader at market to conduct SNAP EBT transactions?
No
Yes
Is this farm operated by a nonprofit agency?
No
Yes
Farm Business Name: ______________________________________________________________________________
Farm’s Total Tillable Acres: ________ Farm’s Anticipated Cultivated Acres in Fruits/Vegetables This Season: _________
Principal/Owner’s Name(s)(“Farmer”): ________________________________________________Title: ______________
Business Mailing Address: ___________________________________________________________________________
City: __________________________________ State: _____ Zip: ________ Farm County: ________________________
Home Phone: (_____) ___________________________ Cell Phone: (_____) ___________________________________
☐ email
☐ mail
☐ phone
E-mail: _____________________________________
ommunication preference:
C
List of Markets
List all markets you plan to attend this season (June – November) and include your personal
:
farm stand, if you operate one. Farm stand operators must submit a Market Participation Agreement (FMC-8)
for their farm stand if they want to accept FMNP checks there. Use the backside for additional listings.
County
Market Name
Check Day(s) in Attendance
1. ____________
_________________________________________
Sun
Mon
Tue
Wed
Thu
Fri
Sat
2. ____________
_________________________________________
Sun
Mon
Tue
Wed
Thu
Fri
Sat
3. ____________
_________________________________________
Sun
Mon
Tue
Wed
Thu
Fri
Sat
4. ____________
_________________________________________
Sun
Mon
Tue
Wed
Thu
Fri
Sat
5. ____________
_________________________________________
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Farmer Signature.
I have read and agree to abide by all rules and regulations outlined in the New York State FMNP
Rules and Procedures for Farmers (FMC-5) provided by the NYS Department of Agriculture and Markets (Department).
By signing below, I certify that all information is true and correct to the best of my knowledge.
Signature(s) (Required):
______________________________________________________ Date: ____________
N/A, I manage my own farm stand and I do not attend any other FMNP markets; a counter-signature is not required.
Market Manager/Sponsor Counter-signature.
As market manager/sponsor for a market listed above, I certify that
the above farmer is a vendor at my market this year and is eligible to participate in the FMNP this year at my market.
Market Signature (Required): ____________________________________________________ Date: ____________
Market Manager/Sponsor Name (Printed): _____________________________________________________________
Submit applications by: EMAIL: farmersmarkets@agriculture.ny.gov; FAX (518) 457-8398;
MAIL:
NYS Department of Agriculture and Markets
Attention: FMNP
10B Airline Drive Albany NY 12235;
PHONE: Toll-free (800) 554-4501
Albany (518) 457-7076 x1
This institution is an equal opportunity provider.
Rev 1/2020
Farmers’ Market Nutrition Program (FMNP)
FARMER PARTICIPATION AGREEMENT (FMC-6)
CLEAR FORM
Stamp in the box below using the official FMNP stamp issued to you last year or the last year you participated:
Or: I lost my stamp and I need a replacement stamp (check here):
Or: this is my first year participating in the program (check here):
Interactive training is mandatory for farmers new to the FMNP.
If you are new to the FMNP, please indicate your training status:
I trained on this date: _________ or
I plan on training or
N/A, I am not new to the FMNP; I read the rules.
Does your farm have its own EBT card reader to use on the farm and/or at market?
No
Yes
In-Progress
If yes, do you use this EBT card reader at market to conduct SNAP EBT transactions?
No
Yes
Is this farm operated by a nonprofit agency?
No
Yes
Farm Business Name: ______________________________________________________________________________
Farm’s Total Tillable Acres: ________ Farm’s Anticipated Cultivated Acres in Fruits/Vegetables This Season: _________
Principal/Owner’s Name(s)(“Farmer”): ________________________________________________Title: ______________
Business Mailing Address: ___________________________________________________________________________
City: __________________________________ State: _____ Zip: ________ Farm County: ________________________
Home Phone: (_____) ___________________________ Cell Phone: (_____) ___________________________________
☐ email
☐ mail
☐ phone
E-mail: _____________________________________
ommunication preference:
C
List of Markets
List all markets you plan to attend this season (June – November) and include your personal
:
farm stand, if you operate one. Farm stand operators must submit a Market Participation Agreement (FMC-8)
for their farm stand if they want to accept FMNP checks there. Use the backside for additional listings.
County
Market Name
Check Day(s) in Attendance
1. ____________
_________________________________________
Sun
Mon
Tue
Wed
Thu
Fri
Sat
2. ____________
_________________________________________
Sun
Mon
Tue
Wed
Thu
Fri
Sat
3. ____________
_________________________________________
Sun
Mon
Tue
Wed
Thu
Fri
Sat
4. ____________
_________________________________________
Sun
Mon
Tue
Wed
Thu
Fri
Sat
5. ____________
_________________________________________
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Farmer Signature.
I have read and agree to abide by all rules and regulations outlined in the New York State FMNP
Rules and Procedures for Farmers (FMC-5) provided by the NYS Department of Agriculture and Markets (Department).
By signing below, I certify that all information is true and correct to the best of my knowledge.
Signature(s) (Required):
______________________________________________________ Date: ____________
N/A, I manage my own farm stand and I do not attend any other FMNP markets; a counter-signature is not required.
Market Manager/Sponsor Counter-signature.
As market manager/sponsor for a market listed above, I certify that
the above farmer is a vendor at my market this year and is eligible to participate in the FMNP this year at my market.
Market Signature (Required): ____________________________________________________ Date: ____________
Market Manager/Sponsor Name (Printed): _____________________________________________________________
Submit applications by: EMAIL: farmersmarkets@agriculture.ny.gov; FAX (518) 457-8398;
MAIL:
NYS Department of Agriculture and Markets
Attention: FMNP
10B Airline Drive Albany NY 12235;
PHONE: Toll-free (800) 554-4501
Albany (518) 457-7076 x1
This institution is an equal opportunity provider.