Lowell Farmers’ Market 2015 Application Fridays, 12:00pm-5:00pm July 10-October 30 (Excluding July 24th) City Hall JFK Plaza, 50 Arcand Drive www.merrimackvalleysmallbusiness.com www.facebook.com/LowellFarmersMarket Submit Completed Application To: Stacie Frechette, Market Manager | sfrechette@commteam.org | 978.322.8400 Community Teamwork, MVSBC | 88 Middle Street, Suite 202 | Lowell, MA 01852 Please Note: All products must be grown/produced in New England to be sold at the Lowell Farmers’ Market. Legal Business Name: ________________________________________________________________________________ Owner(s): _________________________________________________________________________________________ Primary Contact: __________________________________________________ Cell Phone: (_____)________________ Title: ___________________________ Email: ___________________________________________________________ Business Address: ________________________________________ City, State___________________ Zip: __________ Business Mailing Address (if different): __________________________________________________________________ Website: ________________________________________________________________ #Tag(s): __________________ Facebook: __________________________ Twitter: _____________________ YouTube: _________________________ Business Legal Entity (Circle One): Sole Proprietor / LLC / S. Corp / C. Corp / Partnership / Non-Profit Business EIN#: ___________________________ DUNS#: __________________ Business Established Since: __________ Do you have employees? ___ Yes Your business is: (Check all that apply) ___ No (If Yes, how many? FT ____ PT ____ IC ____) __ Minority Owned __ Veteran Owned __ Woman Owned __ Low-Income Owned __ Immigrant Owned (Country of Origin: ________ ) __Disabled Persons Owned What products do you plan to sell at the Market? Please be very specific. __________________________________________________________________________________________________ __________________________________________________________________________________________________ Are you certified by the MA Department of Agricultural Resources to accept WIC and Elder coupons? ___ Yes Are you certified Organic? ___ Yes ___ No (If Yes, please attach documentation.) ___ No For Prepared Food Vendors: Where do you purchase the primary ingredients for your products? ___________________________________________ Does your business have a store front? ___ Yes ___ No If No, indicate where the foods are prepared (proof of operating agreement is required). ______________________________________________________________________ As part of the Merrimack Valley Small Business Center (MVSBC), Lowell Farmers’ Market participants receive $20 off the annual MVSBC Membership Fee. Are you interested in learning more about the following MVSBC services? __ Business Microloans __ Business Counseling __ QuickBooks __ Commercial Kitchen Space __ Business Classes/Trainings __ Marketing 1 | Lowell Farmers’ Market Brought to you by Community Teamwork’s Merrimack Valley Small Business Center Updated 4/16/2015 Payment Levels (Please Check One): Make Checks Payable to Community Teamwork-Farmers’ Market $288 (16 Markets) --Paid In Full before June 26 ($18 per Market) $320 (16 Markets) --Paid In Two $160 Installments: June 26 / August 28 ($20 per Market) $25 each (8 Min) --Deposit $50 before June 26, $25 per Week Thereafter $30 each --Paid One Week in Advance Payments not received one week prior to reserved market date(s) will incur a $15 fee per market. Limited Onsite Vendor Parking Is Available By Request. (1 spot per vendor; Must be reserved in advance.) The Lowell Farmers’ Market is open for 16 Fridays. Please circle the date(s) you wish to reserve or check “All Markets.” July 10 July 17 July 31 Aug. 7 Aug. 14 Aug. 21 Aug. 28 Sept. 4 ___ Sept. 11 Sept. 18 Sept. 25 Oct. 2 Oct.9 Oct. 16 Oct. 23 Oct. 30 All Markets I give the Lowell Farmers’ Market and its affiliates permission to use images and information about my business for marketing purposes. I give the Lowell Farmers’ Market and its affiliates permission to add my name and email address to their e-news list so that I may receive important program updates. I certify (and can show proof upon request) that my products are grown and/or produced in New England. Print Name: ___________________________________________________________ Title: ____________________ Signature: _____________________________________________________________ Date: ____________________ By signing this form, I verify that the information provided is accurate to the best of my knowledge. Community Teamwork Pre-Assessment (To be completed by business owner) Optional As a program of Community Teamwork, we ask the following questions to help determine if you may benefit from other Community Teamwork programs. Depending upon your needs, we may be able to provide additional services or refer you to a different agency for assistance. In some cases, there may not yet be services in place to help you, but your answers to these questions will help us develop those critical services in the future. Thank you for sharing this information with us: Internal Use Only: Octopia Entry # _________ Yes No N/A Are you currently behind on your rent or mortgage? Are you in danger of foreclosure or eviction? Do you think your housing poses a health risk? Are you currently behind on your heating or utility bills? Do you have enough food right now to feed yourself and your family? Do you need help finding or paying for child care? Does any adult in your household need help obtaining a high school diploma or GED? Does any adult in your household need help improving their English language skills? Is transportation a problem for you or anyone in your family? Does anyone in your household need help finding a job? Would anyone in your household be interested in gaining new job skills? Does everyone in your household have health insurance? Can everyone in your family get the health care they need? Is anyone in your household pregnant? Does anyone in your life ever frighten, intimidate or try to control you or others in your family? Are you worried about the safety of anyone in your family? The Lowell Farmers’ Market is managed by the Merrimack Valley Small Business Center, a program of Community Teamwork, in collaboration with Middlesex Community College, the University of Massachusetts Lowell, and the City of Lowell – Division of Planning & Development. Community Teamwork is a catalyst for social change. We strengthen communities and reduce poverty by delivering vital services and collaborating with key stakeholders to create housing, education and economic opportunities. www.commteam.org 2 | Lowell Farmers’ Market Brought to you by Community Teamwork’s Merrimack Valley Small Business Center Updated 4/16/2015