Buying Local Directory Enrollment Form

Participant qualifications: In addition to being a member in good standing of Ohio Farm Bureau, the retail business must be operated by the producer of the agricultural and/or horticultural products that are being sold directly to the consumer. These businesses may also sell agriculture-related entertainment programming such as hayrides, corn mazes and more. The business may sell products in addition to those he or she produces and the products may be processed or unprocessed.

Businesses found in the directory typically fall into one of these categories: Roadside stand or market, farm market, farmers' market, winery, Christmas tree farm, pick-your-own or U-pick, garden center/retail greenhouse, agritourism, produce auction or Community Supported Agriculture.

General Information

First Name		**
Last Name		**
County	Adams Allen Ashland Ashtabula Athens Auglaize Belmont Brown Butler Carroll Champaign Clark Clermont Clinton Columbiana Coshocton Crawford Cuyahoga Darke Defiance Delaware Erie Fairfield Fayette Franklin Fulton Gallia Geauga Greene Guernsey Hamilton Hancock Hardin Harrison Henry Highland Hocking Holmes Huron Jackson/Vinton Jefferson Knox Lake Lawrence Licking Logan Lorain Lucas Madison Mahoning Marion Medina Meigs Mercer Miami Monroe Montgomery Morgan Morrow Muskingum Noble Ottawa Paulding Perry Pickaway Pike Portage Preble Putnam Richland Ross Sandusky Scioto Seneca Shelby Stark Summit Trumbull Tuscarawas Union VanWert Vinton Warren Washington Wayne Williams Wood Wyandot
FB Member Number (Found on your OFBF membership card or by contacting your county farm bureau office)		**
Your Phone (xxx) xxx-xxxx		**
Your Email
Your Email (again)
*Business Name		**
*Business Street Address		**
*Business Street Address (Line 2)
*City		**
*State		**
*Zip		**
*Business Phone (xxx) xxx-xxxx		**
*Web Link
*Business Email
*Business Email (again)
Check here if you do not want the business email address publicized.
Check here if you would like to receive future e-newsletters from us.

*Type of Business (check all that apply)

Agritourism	Farm Market (a producer offers products for sale)	Llamas	Winery
Alpacas	Farmer's Market (multiple producers congregate)	Pick-your-Own/ U-Pick	Other
Christmas Trees	Garden Center/Retail Greenhouse	Produce Auction
Community Supported Agriculture (CSA)	Horses	Roadside Market

*Months of Operation and Days and Hours Open (please describe)

Brief list of products available

*Fruits and Vegetables (check all that apply)

Apples	Eggplant	Radishes
Asparagus	Grape Juice	Red Raspberries
Beans	Grapes	Rhubarb
Beets	Greens	Squash
Blackberries	Herbs	Strawberries
Black Raspberries	Lettuce	Sweet Corn
Blueberries	Melons	Tomatoes
Broccoli	Onions	Turnips
Cabbage	Peaches	Watermelon
Cantaloupe	Pears	Wine
Carrots	Peas	Zucchini
Cauliflower	Peppers	Certified Organic
Celery	Plums	Other
Cherries	Potatoes
Cucumbers	Pumpkins

*Meats (check all that apply)

Beef	Poultry	Pork
Fish	Shrimp	Goat
Lamb		Other

*Other (check all that apply)

Baked Goods	Honey	Cheese
Cider	Jams & Jellies
Eggs	Maple Syrup	Other

*Plants (check all that apply)

Annuals	Perennials	Other
Bedding Plants	Shrubs - Balled & Burlap - Bare Root - Container
Dried Flowers	Trees - Balled & Burlap - Bare Root - Container

*Christmas Trees (check all that apply)

Austrian Pine	Douglas Fir	White Pine
Blue Spruce	Fraser Fir	White Spruce
Canaan Fir	Norway Spruce	Other
Concolor Fir	Scotch Pine

*Services for Christmas Trees (check all that apply)

Balled & Burlap	Cut-Your-Own	Tree Baling
Pre-Cut	Shaking

*Agritourism (check all that apply)

Animal Exhibits	Maze	Other
Hayrides	Tours

*Other Products and Services (include anything not previously listed)

I request and give the Ohio Farm Bureau permission to list my business information on the Buying Local Directory at http://www.ourohio.org. I understand that I must maintain my membership in the Ohio Farm Bureau Federation (except farmers' markets and produce auctions) and conduct a legal and ethical business to maintain this listing. It is my responsibility to notify the Ohio Farm Bureau Federation of changes to be made in the directory.

Name: Date:

Contact Rebecca Everman at (614) 246-8241 or buylocal@ofbf.org with questions or to update farm market listing information.
* This information will appear on the web site.
** This information is required.

EVENTS - Ohio Farm Bureau encourages Buying Local Directory participants to submit events for publication on OurOhio.org. Contact Lynn Snyder or complete the on-line Events submission form.