Farmer Application Harvest of the Month

First and Last Name*

Farm Name*

Mailing Address*

Farm address

Enter farm address if different from mailing address

Cell phone (with area code)*

Work phone with area code

Email*

Farm Website*

Certified Organic*

Registered Organic*

Years in operation*

Have you provided produce for the Harvest of the Month Program in the past?*

Select which month(s) you'd be interested in supplying for Harvest of the Month

Please list what produce you'd be able to provide for the month(s) selected. We will approximately 9,500 tastes for each month of produce.

Any additional information you want to share with us about the produce or other items.

Do you identify with any of the following groups that have been excluded from Agriculture in the United States?

Mark all options that apply for you.