HAFM Electronic Entry Application Form

Harbor Area Farmers Markets
Electronic Entry Application Form
Farm Name on Certificate:
Certificate #:...Issuing County:...Expires on:
What is your approximate normal selling season?
How much selling space (width in feet) do you think you need? 10', 20', other?
Farm Mailing Address:
Farm E-mail Address:....Farm Fax #:
List all current Farm phone #s:
Your Name/Relation to Name on Certificate:
Your Personal Mailing Address:
Your E-mail Address:....Your Fax #:
Your Home phone #:....Your Cell phone #:
Does this farm ever carry any Second Certificates?
If yes, what is the name on the first of these Second Certificates?
2^nd Certificate #:.Issuing County:.Expires on:
When do you carry this Second Certificate?
What is the name on the second of these Second Certificates?
2^nd Certificate #:.Issuing County:.Expires on:
When do you carry this other Second Certificate?
List all employees who sell for you:
List all markets where you currently sell:

NON-AGRICULTURAL APPLICANTS:

Company Name:....Business phone #:
Company Mailing Address:
Company E-mail Address:....Company Fax #:
Your Name:....Your Home phone #:
Type of Permit which Company uses:
Permit #:....Expires on:
Products to be sold:

PLEASE SEND SEPARATELY THE APPROPRIATE FOLLOWING ITEMS
either thru the regular mail, or as E-mail attachment, or via Fax:

a) Copy of your current Certified Producer's Certificate or Health Permit(s);
b) Copy of all Second Certificates if you carry any.

These additional documents may be sent to:
Harbor Area Farmers Markets, 759 Linden Ave, Long Beach, CA 90813,
E-mail address: hafm AT earthlink DOT net or FAX #: (562) 433-1415.

WHEN PRESSING THE SUBMIT BUTTON BELOW,
your electronic entry application form filled out above will be automatically e-mailed to HAFM.