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Contact Name *

First Name

Last Name

Phone Number

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Address *

Address 1

Address 2

City

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Zip/Postal Code

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Are you a home-based vendor? *

Yes

No

Are you an Indiana Grown member? (Membership is not required.) *

Yes

No

Please check all that apply.

I am primarily a food processor, manufacturer or co-packer.

I distribute local foods to schools in Indiana.

I have the ability to package my product in food service compatible packaging.

I am registered with the Indiana State Department of Health as a farmer or distributor.

I have a GAP Harmonized Audit.

I have a 3rd party audit certificate.

I need assistance finding food safety compliance resources