Individual Market Information Form

Individual Market and Market Operator Information

Online Fill-in and Submission Form

Check One:

Confirm Present Listing Update Listing Add New Listing

Date:

Name of Person Submitting Form:

Market Certificate Number:

Market County:

Market City:

Market Name:

Actual Market Site Address or intersection of Market including zip code:
(For internet map purposes):

Location Description:

Day of the Week:

Operating Hours:

Operating Season (month start/end):

Name of Market Operator:

Operator is: (Check One)

Certified Producer Producer Association Non-Profit Organization Government Entity

Average Number of Certified Farmers selling each Market Day:

Under 10 Farmers 10 to 20 Farmers 21 to 35 Farmers Over 35 Farmers

Market Contact Person:

Market Phone:

Market Mailing Address:

Mailing City and Zip Code:

Website Address:

E-mail Address:

Comments: (describe any specific changes or additions)

Enter text as shown in image above

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