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GENERAL INFORMATION
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PRODUCER APPLICATION
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Business Name:
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Business Phone:
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Business Address,
City, State and Zip:
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Product type:
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Contact Information
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Primary Contact:
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Primary Phone:
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Primary Email:
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Primary Address, City,
State and Zip:
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Secondary Contact:
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Secondary Phone:
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Secondary Email:
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REFERENCES
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Reference A: Name:
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Reference A: Phone:
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Reference A: Relationship:
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Reference B: Name:
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Reference B: Phone:
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Reference B: Relationship:
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EXPERIENCE
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How long have you been in
business?
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How much experience do you have in a Commercial kitchen?
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KITCHEN USAGE
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| Which Kitchen Area
do you plan to use?
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Kitchen Area 1- Prep Area, Blast freezer,
Dehydrating Ovens, shared 6 burners on Stove
Kitchen Area 2 – Prep Area, Double Full
Size Convection Ovens, 20 qt mixer, shared 6 burners on Stove
Kitchen Area 3 – Prep Area, share 6 burners on
stove, 65 qt steam kettle |
| How much kitchen time
do you plan to schedule?
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80 hrs a mth = 5 - 4hr slots a week
64 hrs a mth = 4 - 4hr slots a week
48 hrs a mth = 3 - 4hr slots a week
32 hrs a mth = 2 - 4hr slots a week
16 hrs a mth = 1 - 4hr slots a week
8 hrs a mth = 2 - 4hr slots a Month
4 hrs a mth = 1 - 4hr slots a month |
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Do you have personal
equipment you need to house on the floor of kitchen?
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Yes
If yes, What equipment?
No
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STORAGE
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List the amount of storage you anticipate needing
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| INGREDIENT DRY SHELF (18"x36"x18") |
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| INGREDIENT PALLET (48"x48"): |
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| REFRIGERATOR SHELF (12"x18"x18"): |
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REFRIGERATOR BOX STACKING (24"X24"X72")
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| FROZEN DRY SHELF (9"x18"x18"):: |
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INSURANCE
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| What is the status of your
liability insurance? |
In processComplete |
| Who is your insurance agent?: |
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What is your policy number?
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If in process, what is the
expected completion date?
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LICENSES
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What is the status of your
Health Department License?
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What is your license number?
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Does your product require a
process authority letter?
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RESOURCES
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Do you use locally grown
ingredients?
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Are you interested in any specific
locally grown items?
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Do you order ingredients through a
food purveyor? Which One?
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Are you interested in cooperative
purchasing of ingredients or packaging?
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| Do you use any of the
following packaging? |
Canning Jars
Clamshells
Heat Seal Bags |
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MISC
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Is there anything else you need us
to know?:
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Please tell us how you heard about
us::
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What is the email address or name used
to pay your application fee on Paypal?:
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