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2. Leroy James Farmers Market

   4560 County Home Road

   Greenville, NC 27858

3. (Farmers Market staff only) Yearly Fee Paid
5. Full Name
7. Mailing Address
9. City & Zip Code
10. Home County
12. Phone
14. E-mail
16. Total Acreage in Production
17. Farms Service Number
19. Commodity

    1. Apples
    2. Asparagus
    3. Beans
    4. Beets
    5. Berries (Other than Strawberries)
    6. Broccoli
    7. Cabbage
    8. Cantaloupes
    9. Corn
    10. Cucumbers
    11. Eggplant
    12. Flowers (Cut)

    1. Grapes
    2. Greens
    3. Lettuce
    4. Mushrooms
    5. Okra
    6. Onions
    7. Peas
    8. Peaches
    9. Pears
    10. Pecans
    11. Pepper: Sweet
    12. Pepper: Hot

    1. Plants
    2. Potatoes: Irish
    3. Potatoes: Sweet
    4. Pumpkins
    5. Radishes
    6. Squash: Summer
    7. Squash: Winter
    8. Strawberries
    9. Tomatoes
    10. Turnips
    11. Watermelons
    12. Other
21. If other, please list here:
23. By checking this box, you agree that the information on this form is accurate and you are the person listed on this application.

    1. Agree
24. Date
    Date
26. Submitted by/Electronic Signature*

    Please print full name

28. ***$50 yearly fee is non-refundable, payable to Leroy James Farmers Market and submitted to Larita Johnson via cash or check at the Farmers Market***

32. This section is for Farmers Market staff only. Please do not fill in any information into the below questions.

34. Vendor #
35. Certified by (Farmers Market Staff Full Name)
37. Phone
38. E-mail
39. Date
    Date
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field