Membership Form | Adirondack Harvest

1) ADMINISTRATION DETAILS
Create Login Password:

2) FARMER/PRODUCER CONTACT INFO: * indicates a required field.

Owner's First Name*:
Owner's Last Name*:
Telephone*:
Business Name*:
Fax:
Street Address*:
Town*:
State*:
ZIP Code*:
County:
Township:
Website:
Email Address*:
Business Type*:	Farm - Farm Stand Processor Restaurant Store Wholesalers

3) MARKETING:
We sell by:

retail only
direct to restaurants, stores, or processors
distributor (list name and phone number)
farmers market (which ones?)
farmstand
other
delivery available

Ordering Method(s):

phone/email orders taken
online orders taken
will ship
on site sales
other:

4) FARM PRODUCT INFO:
Meats: USDA inspected: Yes No

beef veal goat lamb poultry pork fish venison other:

Vegetables: Please list all you would like featured in the description:

Fruits: apples cherries grapes melons pears plums rhubarb strawberries
raspberries blueberries blackberries other:

Dairy & Eggs: milk ice cream eggs yogurt cheeses (types):

Value-added Products/Ornamentals:
baked goods candies cider cut flowers dried fruits fruit syrups honey Indian corn gourds
dried herbs jams, jellies maple syrup mustards nuts speciality sauces/dressings
tofu herbal vinegars wine other:

5) ADDITIONAL INFORMATION:
all-natural products Certified Organic Certified Naturally Grown Other:

6) ADDITIONAL INFORMATION REQUIRED BY RESTURANTS & STORES:
Identify at least two farmers from whom you purchase products:

7) DESCRIPTION (2000 CHARACTERS/SPACES OR LESS)

Be as descriptive as possible - list your business highlights, hours of operation, history, etc.

You typed 0 characters Max. Length: 2000 Characters

8) One photo may be loaded into your description. If you have a physical photo that you would like to use, please mail it in with your payment check. We will return photos at your request. If you would like to use a photo you have in digital form, you can email it to us when we contact you about your application. You can also upload the photo by using the field below.

Mail payment check (and photo if desired) to:
Adirondack Harvest
PO Box 388
Westport, NY 12993