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If you want to download the pdf copy of the application please Click here
 
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VENDOR APPLICATION FORM
  Account Holder Information
User Name 
Password Required Field      [Minimum 6 characters long and can have only alphabets and numbers]
Confirm Password  
First Name 
Last Name 
Street Address 
City 
State 
Zip 
County 
E-mail Address   (ex: pat@example.com)
Main Phone Number   (xxx-xxx-xxxx)
Cell Number   (xxx-xxx-xxxx)
  Training & Farmers Market Information
 
Training is required once every three years. If you do need training - or have already taken training this year, please select the date and location you attended or plan to attend from the drop down boxes below. For a detailed listing of the training locations, please Click here.
 
My next training year 
Training Date   (mm/dd/yyyy)
Training Location   (Select a training date to get the corresponding training locations.)
 
Farmers Market Nutrition Program checks and WIC Cash Value Vouchers can only be accepted at authorized farmers markets, during authorized days and times. Farmers market cannot be authorized until the certified vendor requirement is met. Verify with the Market Manager that the market has been authorized prior to accepting any FMNP checks or WIC Cash Value Vouchers.

Please enter the market information below. Markets that occur more than one day a week, will be listed more than once in the "FMNP Farmers Market" drop down box below. In these instances, please select the market(s) that provides you with the appropriate "weekday" and market calendar dates.
 
AVAILABLE FMNP MARKETS   
*[A] - Authorized, [N] - Not Authorized, [P] - Pending  
* If you want to participate in any of the FMNP markets available below, select the market and enter the start and end dates you want to participate and also make sure that you enter valid dates between market start and end dates. Otherwise your application may not be approved. * Please note: IDALS is awaiting more information on many 'pending' markets. Dates listed for pending markets may not be the actual market dates. If you need additional market date information, please contact the market managers for those markets.
FMNP Farmers Market
WeekDay
Market Start Date
(mm/dd/yyyy)
Market End Date
(mm/dd/yyyy)
Your Start Date
(mm/dd/yyyy)
Your End Date
(mm/dd/yyyy)
Market Manager
Phone
Upon approval to participate as a vendor in the FMNP program, if necessary you may log in and add additional markets.
  Please answer all of the following questions
1. Are you at least 18 years of age, reside and grow produce in Iowa or in a county adjacent to Iowa? Yes No
2. What percent of the total fresh fruits, vegetables and/or herbs that you take to each market do you personally grow? %
3. Do you have a moveable or permanent farmstand that you would like authorization for in the 2017 Farmers Market Nutrition Program (these are stands that operate outside of FMNP-authorized markets)? The farmstand must be open a minimum of two hours each week for a majority of the season or 11 consecutive weeks. Farmstands require approval before inclusion in the program.
If you select "Yes", you need to fill out the following 'Farmstand Assurance Statement' section as well.
Yes No
4. Have you or any of the officers or owners of this operation had a conviction or civil judgment related to business integrity (for example, fraud, theft) entered against them in the last six years? Yes No
Vendors who are disqualified from participation in, or have a civil monetary penalty imposed by the Food Stamp Program shall be automatically suspended or disqualified from the WIC / Senior FMNP and WIC CVV.
5. Has your operation had a Food Assistance (Supplemental Nutrition Assistance Program SNAP) disqualification or civil monetary penalty imposed within 12 months of the date of this application? Yes No
6. Would you like IDALS to provide you with a letter providing an overview of the FMNP program that you can provide to your financial institution? Yes No
You must display a certified vendor identification sign at all times you accept or intend to accept FMNP checks and WIC Cash Value Vouchers at an authorized farmers market/farmstand.
7. Number of certified vendor identification signs I request (typically one per stall)
 
A copy of the Vendor Certification Handbook will be sent to you with your certified vendor materials. If you want to download Vendor Certification Handbook from our website, Click here.
 
  Vendor/Department Agreement
 
Vendor/Department Agreement
2017 WIC/Senior Farmers Market Nutrition Program & WIC Cash Value Vouchers
 
 I agree to the rules and regulations of the Vendor/Department Agreement.
 
  Contact Us
If you have any questions, please contact:
Paul Ovrom
Farmers Market Nutrition Program
Iowa Department of Agriculture and Land Stewardship
Wallace State Office Building
502 East 9th Street
Des Moines, IA 50319

E-mail: paul.ovrom@iowaagriculture.gov
Telephone: 515-242-6239
Fax: 515-242-5015


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