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FITM <br />Business/Farm name: <br />Name of primary seller: <br />Street address: <br />Lauderdale Farmers Market in the Park <br />Thursdays: July 17,, August 21,, and September 18, 2014 <br />4:00 <br />Lauderdale Community Park <br />I nPUM 111111 Alw,,n W 3my <br />City: —State: Zip: <br />Home phone: Cell P one: <br />119 <br />Website: <br />Address where crops are grown or items are produced: <br />Do you grow or produce all your items? (circle one) YES NO <br />If not, please explain: <br />Are your items organic? Organic Certified Organic Neither <br />Are you selling any processed food items? (circle one) YES NO <br />If you answered yes to the previous question, you agree to abide by the "Pickle Bill" regulations <br />and hold necessary food licenses? (circle one) YES NO <br />All of your bakery items are made from scratch? (circle one) YES NO <br />What food related licenses do you currently hold? <br />Please list all items you intend to sell at the market. Items not listed may not be sold at the market <br />without Market staff approval. Add additional page if necessary. if possible, list specific varieties. <br />