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pdfUSDA Farmers Market Application Form TM-28
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Applying to the U.S. Department of Agriculture USDA Farmers Market 2017
Please Read
(This box is scrollable. Please scroll down to read all application requirements.)
Please read through the 2017 USDA Farmers Market Rules, Procedures, and Operating Guidelines before
applying online. This application is to participate in the daytime USDA Farmers Market, which runs 9 a.m.
to 2 p.m. every Friday from May to October. The market is located in Washington, DC outside USDA
Headquarters on the National Mall.
Applications will NOT be reviewed unless complete. A completed application includes the following:
o Complete this electronic application by signing and dating;
o Submit a complete list of products or menu items along with a list of ingredients for each item and sources
Market Dates
Select the dates you would like to attend. (select all)
May 2017
June 2017
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July 2017
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August 2017
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September 2017
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October 2017
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Market Staff
USDA Farmers Market Application Form TM-28
Market Staff
Please select all those that will be staffing your booth this season.
ex: John Smith
edit
Add New Staff
Vendor Type
Please select your vendor type.
Farmer I own or lease a farm in the Chesapeake Bay region (including the states of Delaware,
Maryland, New York, Pennsylvania, Virginia and West Virginia), and preferably within a 200mile
radius of Washington, D.C. The grains, herbs, fruits, vegetables, and other products I wish to sell are
produced on this land in fields and/or greenhouses. I understand that the resale of agricultural
products by farmers, ranchers and growers is not permitted at the USDA Farmers Market.
Grower I am a grower who owns or leases the land my flowers, plants, bedding plants, trees and
other products are produced on in the Chesapeake Bay region (including the states of Delaware,
Maryland, New York, Pennsylvania, Virginia and West Virginia), and preferably within a 200mile
radius of Washington, D.C. I understand that the resale of agricultural products by farmers,
ranchers and growers is not permitted at the USDA Farmers Market.
Rancher I am a rancher who owns or leases the land the fowl, and/or herd or other products I wish
to sell are produced on in the Chesapeake Bay region (including the states of Delaware, Maryland,
New York, Pennsylvania, Virginia and West Virginia), and preferably within a 200mile radius of
Washington, D.C. I understand that the resale of agricultural products by farmers, ranchers and
growers is not permitted at the USDA Farmers Market.
Meat Processor I primarily operate a food processing facility that processes meat raised by
regional farmers or ranchers. I understand that sales of fresh meat or poultry products are prohibited
at the USDA Farmers Market. Only frozen meat and frozen poultry products that have been
processed in a USDA Food Safety Inspection Service (FSIS) licensed and inspected facility and
bear the USDA seal of inspection are permitted.
Cheese/Butter/Yogurt/Frozen Dairy Product Maker I make cheese and other valueadded products
from milk that is purchased from dairy farms in the Chesapeake Bay region or from my own herd. My
flavoring agents are sourced locally. Exotic, outofregion flavorings are used minimally.
Fisherman/Waterman I raise or catch fresh fish and shellfish, and use my own or local processing
facilities so that these seafood products can be sold at market.
Value Added Food Producer I make jellies and jams, preserves, syrups, salsas, flavored oils,
vinegars, pickles, fermented products, and dried products using produce grown by a farmer, rancher
or grower in the Chesapeake Bay region.
Specialty I make other agricultural product(s), which are not currently available at the USDA
Farmers Market and/or in the Chesapeake Bay region but are important to the agricultural economy
in the United States. I understand that speciality products will be considered on a casebycase
basis.
Baker I make freshly baked goods from scratch, using ingredients from the Chesapeake Bay
region as much as possible. My baked goods are handled in accordance with the rules and
regulations described by the state and local health department in which my farm or production
facility is located.
Pasta Maker I make pasta and sauces from scratch, using ingredients from the region. A minimum
of 75 percent of the ingredients (by item, not by weight) in the products I wish to sell are sourced
directly from a farmer, rancher or grower in the Chesapeake Bay region. I understand that water,
salt, pepper, oil, and sugar are excluded from the 75 percent requirement.
Soap Maker I make handcrafted soaps and/or other healthcare products from scratch. A minimum
of 75 percent of the ingredients (by item, not by weight) in my products are sourced directly from a
farmer, rancher or grower in the Chesapeake Bay region. I understand that water, salt, pepper, oil,
and sugar are excluded from the 75 percent requirement.
Food Concessions I make readytoeat food and beverages that will be prepared partially or
entirely at the USDA Farmers Market. A minimum of 75 percent of the ingredients (by item, not by
weight) in the products I wish to sell are sourced directly from a farmer, rancher or grower in the
Chesapeake Bay region. I understand that water, salt, pepper, oil, and sugar are excluded from the
USDA Farmers Market Application Form TM-28
75 percent requirement. I understand that exotic, out of region ingredients will be admitted on a
casebycase basis. My products are not heat and serve and prepared offsite.
Coffee/Teas/Juices/Beverage Maker I make drinks from scratch using locally sourced ingredients
from the Chesapeake Bay region. I understand that exotic, outofregion agricultural ingredients
used to make a beverage will be considered on a casebycase basis. I understand that the sale of
water or resale of beverages from another maker is prohibited at the USDA Farmers Market.
Stall Preferences
Preferred Size 10x10 feet
Stall preference notes. Include how many stalls you would like.
You have 2048 characters remaining.
Payment Option
Please select your payment option.
No Market Fee USDA does not charge a fee to farmers, growers and producers who participate in
the USDA Farmers Market. Participants are required to commit to supporting the USDA
gleaning/food recovery initiative in lieu of paying market fees. This commitment requires market
participants to donate fresh useable produce and other food products at the end of each market to
DC Central Kitchen. For participants unable to donate their own product, we request that you
purchase food items from other market participants to donate or give a monetary donation to DC
Central Kitchen. 100% participation from USDA Farmers Market farmers, growers and producers is
expected. Failure to participant may result in suspension or termination from the market.
Additional Questions
1. Do you plan to use the USDA Farmers Market as a CSA pick up location?*
Yes No
2. How many miles is your business from the USDA Farmers Market?*
2048 characters remaining
3. What percentage of ingredients in your products are sourced directly from a farmer, rancher or grower
in the Chesapeake Bay Region? Please provide a percentage.*
2048 characters remaining
4. If a Farmer, Grower or Rancher, what product(s) do you wish to sell at the USDA Farmers Market?
Please provide a full list.
2048 characters remaining
5. If a Producer, please provide a list of all ingredients for every product you wish to sell along with the
name of the farm(s) including address(es) from which ingredients are sourced.
USDA Farmers Market Application Form TM-28
2048 characters remaining
6. Please indicate if your business falls into one of the following Small Business Administration
categories: Veteranowned business; People with Disabilitiesowned business; Womenowned business;
Minorityowned business; or Native Americansowned business?
2048 characters remaining
7. Is your farm or processing facility USDA Certified Organic?*
Yes No
8. Is your business a member of a farmer, rancher, or fishery cooperative?*
Yes No
9. Is your business owned by a USDA employee or a member of a USDA employee(s) household? *
Yes No
Comments
Provide any additional information that you wish to convey to the market manager.
Comments:
2048 characters remaining
Statements
I certify that the information in this application is, to the best of my knowledge, true and accurate and
that I am a legal owner and/or representative of the above named farm/business.
Market Legal Agreement
(This box is scrollable.)
I certify that I have read, understand and agree to adhere to all applicable rules and guidelines as outlined
and referenced in the USDA Farmers Market 2017 Rules and Procedures and Operating Guidelines. I further
understand that should I fail to comply with these specified rules and guidelines, my participation in the USDA
Farmers Market may be terminated.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0581-0229. The time required
I agree to the above terms
Name of applicant (or name of authorized signing officer)*:
USDA Farmers Market Application Form TM-28
(this serves as your digital signature and acceptance of the above legal agreement)
Submit Application
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| File Type | application/pdf |
| File Modified | 2017-06-07 |
| File Created | 2017-06-07 |