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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. Please list each type of processed food on a separate line with a description

18. Copies of the following documents must be provided to the Leroy James Farmers market as appropriate:

20. Documentation that your kitchen has been inspected by the NC Dept. of Agriculture and Consumer Services (needed for jams, jellies, baked goods, and processed peanuts)
22. Certificate indicating that you have passed the Acidified Foods Class given by NC State University (needed for pickles, chow-chow, etc.)
24. Meat handlers certificate from the NC Dept. of Agriculture and Consumer Services
26. Processing authority letter for cooked peanuts
28. 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
29. Date
    Date
31. Submitted by/Electronic Signature*

    Please print full name

33. ***$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***

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

39. Vendor #
40. Certified by (Farmers Market Staff Full Name)
42. Phone
43. E-mail
44. Date
    Date
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field