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Portage Farmers Market Application 2020

2. Business Name*

4. Primary Contact*

6. Address*

8. City*

9. State*

10. Zip Code*

12. Phone Number*

13. Email Address*

15. Mobile Phone*

16. Website or Facebook Link

18. Please list names of employees, partners or family members who will be selling at the market:*

20. What is your preferred method of communication?*

    1. E-mail
    2. Mail
    3. Phone

21. What products does your business plan to sell?*

    (Please list all products, and be specific. If you plan to resell any products, please provide names and contact information for all farms or businesses where you will be purchasing these products)

23. Identify the primary product category that best represents what your business will sell:*

    1. Produce
    2. Meat
    3. Seafood
    4. Plants/Flowers
    5. Eggs
    6. Crafts/Art/Services
    7. Dairy
    8. Value-Added Food
    9. Prepared Food
    10. Wine/Hard Cider
    11. Other

24. Check all boxes below that describe your operation and production practices: (*By USDA definition)*

    1. Certified Organic*
    2. Grass Fed* or Grass Finished
    3. Using Organic Ingredients*
    4. Certified Naturally Grown
    5. Free-Range/Pastured
    6. Cottage Food
    7. MAEAP-verified
    8. No Added Hormones, Antibiotics
    9. Other

26. Are you interested in participating in our credit/debit and food assistance programs?*

    Please check all that apply. Learn more at mypark.portagemi.gov.

    1. Credit/Debit
    2. WIC Project Fresh
    3. Supplemental Nutrition Assistant Program (SNAP)
    4. Senior Project FRESH
    5. Double Up Food Bucks
27. Are you interested in participating in Special Events?*

    1. Yes
    2. No

29. Tell us about your business:*

    Please write a short biography/story (5 sentences), such as your mission, production practices, history, etc. that we can place on the website/Facebook to promote your business.

31. Please check the dates you would like to apply to participate in at the market below:*

    1. May 10
    2. May 17
    3. May 24
    4. May 31
    5. June 7
    6. June 14
    7. June 21
    8. June 28
    9. July 5
    10. July 12
    11. July 19
    12. July 26
    13. August 2
    14. August 9
    15. August 16
    16. August 23
    17. August 30
    18. September 6
    19. September 13
    20. September 20
    21. September 27
    22. October 4
    23. October 11
    24. October 18
    25. October 25

33. Complete EACH line item with "I agree", "No" or "N/A" (not applicable to your farm or business):*

    1. I have read and understand the Vendor Rules and Guidelines and agree that I and my trained business employees will adhere to them, knowing that failure to do so may result in forfeiture of my table
    2. I plan to resell products (up to 25% of my offerings) from other local growers or businesses to supplement the offerings from my farm or business. I am providing a list of those farms or food business
    3. I will provide copies of all applicable businesses and food licenses with this application
    4. My farm/business has liability insurance for the Portage Farmers' Market. I will provide a copy of my policy when my application is approved
    5. My farm/business does not have liability insurance for the Portage Farmers' Market. I will sign a copy of the "Hold Harmless" agreement when my application is approved
    6. I am willing to complete a vendor profile, provide anonymous weekly sales data, and complete a year-end survey for evaluation purposes to provide valuable data and feedback for the market
    7. I would like to provide samples of my product at the market

35. Please list the product(s) to be sampled:*

37. A Non-Refundable deposit of $75 is due with this application. This deposit will be applied towards your season fee should your application be approved. The remaining seasonal balance is due by April 30, 2020.

39. By signing below, you certify that the information provided on this application is true and accurate and pledge that, as a vendor of the Portage Farmers' Market, you will abide by the 2020 Portage Farmers' Market Rules and Guidelines.

41. Electronic Vendor Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. By signing below, you certify that the information provided on this application is true and accurate and pledge that, as a vendor of the Portage Farmers' Market, you will abide by the 2020 Portage Farmers' Market Rules and Guidelines.

    1. I agree.
43. Electronic Vendor Signature*

44. Date:*
    Date:

48. For Portage Parks and Recreation Staff ONLY

50. Electronic Market Manager Signature

51. Date:
    Date:

53. Electronic Parks Director Signature

54. Date:
    Date:

Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit Submit and Print

* indicates a required field