| Applicant & Farm Information | |||
| Applicant Name | #text(#field(17508)) #text(#field(17509)) | ||
| Name of Farm | #text(#field(17510)) | ||
| #text(#field(17511)) | |||
| Addresses | |||
| |||
| Farm Status | |||
| Farm still in business? | #text(#field(17528)) | ||
| Sales to Qualified End Users (QEU's) | |||
| #text(#field(17533)) | $#text(#field(17534)) | ||
| #text(#field(17535)) | $#text(#field(17536)) | ||
| #text(#field(17537)) | $#text(#field(17538)) | ||
| Average Food Sales to QEU's | $#text(#field(17539)) | ||
| Sales to Non-QEU's | |||
| #text(#field(17541)) | $#text(#field(17542)) | ||
| #text(#field(17543)) | $#text(#field(17544)) | ||
| #text(#field(17545)) | $#text(#field(17546)) | ||
| Average Food Sales to Non-QEU's | $#text(#field(17547)) | ||
| Submission | |||
| Submission ID | #submit_id | ||