Business Name *

Owner Name(s) *

Physical address *

Mail address (if different than above)

Primary phone *

Email Address *

Web site address (include social media addresses, if applicable)

Certification

Inclusion on Directory's map (for listing North Fork Valley members only) Inclusion on Directory's map (for listing North Fork Valley members only) Yes No

Directory description for listing members (300 word maximum)

Directory's Cross Reference Guide for listing members, check all that apply Directory's Cross Reference Guide for listing members, check all that apply Biodynamic Certified Naturally Grown Certified USDA Organic Cheese Community Supported Agriculture (CSA) Farmers Market Participant Fruit Grains & Feed Grass Fed Meats Herbs & Flowers Honey Interns/Apprentice Programs Lodging Meat, Poultry & Eggs Milk Shares Nursery Plants Organization Retailer Specialty Products Vegetables Wine, Cider & Spirits