First Name

Last Name

Email

Mobile

State (Permanent Address)

State (Farm Location) AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

County (Farm Location)

Total Acres (Farm)

How is farm operated? Direct Operated Cash Rent Lease Crop Share Lease Other

What is the farm's ownership structure? Individual Entity Trust/Estate Other

Entity Name

Ownership Structure (Other - Please List)

Any additional information, questions, or concerns you have...

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