market maker information sheet - results verification · pdf file ·...

Market Maker Information Sheet

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Contact Information Salutation: _______ First Name:___________________ Last Name: _____________________

Suffix_______ Title:________________ Email:_______________________________

Primary Phone: (__)___________ Alternate Phone (__)___________ Fax: (_)_____________

Private Contact? Yes No

Affiliations: Check any of these affiliations, organizations, and agencies shown below that you are a member of in your state. These will be noted in your business profile.

� Southern Shrimp Alliance

-By checking the box, I verify that I am an approved member of the shrimp industry in eight states committed to preventing the continued deterioration of America’s domestic shrimp industry and to ensuring the industry’s future viability. SSA serves as the national voice for the shrimp fishermen and processors in Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Texas.

Market Information

� Local � Northeast (USA) � Mid-Atlantic (USA) � Southeast (USA) � Mid-West (USA) � Southwest (USA) � Mountain Plains (USA) � Western (USA) � National � International

Business Details Days/Hours of Operation: Enter the Information about your business here to create a listing for your farm, farmers market, restaurant, or other food-related business.

Business Name:_________________________________________________________________

Address 1:_____________________________________________________________________

City:____________________ State:_________ Zip:_______________ County:_____________


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Email Address:__________________________________________________________________

Your email address is not disclosed to the public. A valid email address is required to receive important information regarding account access and service notifications. We respect the privacy of our users and therefore, we will not sell or otherwise intentionally release your personal information to any third party.

URL (website):__________________________________________________________________ http:// is not required

Brief Description of Business or Product(s) For Businesses: For Consumers: Social Network Links:

Twitter Facebook www.twitter.com/________________ www.facebook.com/___________________ Mailing Address (if different than above):

Address 1:_____________________________________________________________________

Address 2:_____________________________________________________________________

Zip:______________ State:________________ City:__________________________

CREATE YOUR MARKET MAKER BUSINESS PROFILE ONLINE AT: WWW.MARKETMAKER.MSSTATE.EDU


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Dairy Product Type:

� Butter � Cream � Cheese � Cream Cheese

o Cow � Frozen Desserts o Goat � Ice Cream o Sheep � Cream Cheese

� Milk � Yogurt o Cow � Other: ___________________________ o Goat o Sheep

Product Attributes—Producer Verified

� Calcium Fortified � GMO Feed Free � Low or Fat Free � Naturally Processed � No Antibiotics Ever � No Antibiotics Fed � No Artificial Colors � No Artificial Flavors � No Growth Promotants � No Preservatives � Pasture/Grass Fed � Source-Verified � Sustainable Practices � Other:_______________________________________

Product Attributes—3rd Party Certified/Verified

� Certified Humane Care � FDA Inspected � GAP Certified � Halal Certified � Kosher Certified � Natural � Organic (Certified) � Source-Verified � State Environmental Certification � State Inspected � USDA Inspected � Other________________

Product Forms

� Aseptic Packaging � Dried � Frozen � Prepared/Packaged � Bottled � Fermented � Pasteurized � Raw � Canned � Freeze Dried � Prepared/Fresh � Vacuum-Packed � Dehydrated � Fresh � Prepared/Frozen � Other:_______________________________________


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Dairy Product Type (continued):

Methods of Sale

� Community Supported Agriculture (CSA) � Export � Mail Order � Roadside Stand � Debit/Credit Card � Farm to School � On Farm Sales � Wholesale � Farmers Market � Pick-Your-Own � WIC � Delivery � Internet � Retail Storefront � EBT/SNAP � Other:_______________________________________


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Fruit Product Type

� Akee � Banana � Canistel � Apples � Blackberries � Cantaloupe � Apricots � Blueberries � Carambola (Star Fruit) � Atemoya � Boysenberries � Cranberries � Avocado � Calamondin � Currants � Cherries � Fallglo � Figs

o Balaton � Gooseberries � Guava o Sweet � Honeydew � Jackfruit o Tart � Kumquat � Lemon

� Grapefruit � Grapes � Lime o Pink ° Juice ° Key o Red ° Table ° Persian o White ° Wine ° Tahiti

� Limequat � Longan � Loquat � Lychee � Mamoncillo (Genip) � Mango � Mayhaw � Melons � Monstera � Muscadines � Muskmelon � Nectarines � Olives � PawPaws � Peaches � Papaya � Pears � Persimmons � Passion Fruit � Pitaya � Plums � Oranges � Pomegranate � Prunes

o Hamlin � Pummelo � Raspberries o Midsweet � Robinson ° Black o Navels � Sapodilla ° Red o Parson Brown � Sapote ° Yellow o Pineapple ° Mamey � Satsuma o Valencia ° White � Scuppernong

� Star Apple � Strawberries � Sugar Apple � Tangelo � Temple Tangor � Wampee

o Honeybell ° Sunburst � Watermelon o Orlando � Wax Jambo

� Tangerines � Other __________________________________________ o Dancy o Honey o Ponkan


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Nut Product Type � Chesnuts � Hazlenuts � Nuts � Pecan � Peanuts � Pine Nuts ° Boiling � Walnuts ° Green ° Black � Other: ______________________________ ° English


� Biodynamic � Calcium-Fortified � GMO Free � Controlled Atmosphere Storage � High Oleic Content � Iron-Fortified � Hoop House/High Tunnel � Kosher � Lite � Natural � No Artificial Colors � No Artificial Flavors � No Preservatives � Pesticide Free � Source—Verified � Sustainable Practices � Wild Harvest � Other:__________________________________________________________________


� GAP Certified (Standards) � Halal Certified � Kosher Certified � Natural � Organic (Certified) � State Environmental Certification � Other:__________________________________________________________________

Product Forms:

� Bottled � Canned � Cider � Condiments � Cured � Dehydrated � Dressings � Dried � Extract � Flour � Forced-Air Cooled � Freeze-Dried � Fresh � Fresh Processed/Packaged � Frozen � Hydro-Cooled � Individually Quick Frozen � Jams/Jellies � Juice � Meal � Oil � Pasteurized � Pickled � Prepared/Frozen � Refrigerated � Salsa � Sauces � Smoked � Unpasteurized � Vacuum-packed � Wine � Other:_______________________________________


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Fruit & Nut Product Type (continued):

Methods of Sale

� Community Supported Agriculture � Debit/Credit Card � Delivery � EBT/SNAP � Export � Farm-to-School � Farmers Market � Internet � Mail Order � On Farm Sales � Pick-Your-Own � Retail Storefront � Roadside Stand � Wholesale � WIC


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Grain Product Type:

� Amaranth � Annual Bunch Grass � Barley � Beans � Bengal Gram � Black Lentil

o Adzuki � Buckwheat � Bulgur o Anasazi � Camelina � Canola o Black � Cassava � Channa Dal o Black Spanish � Chufa � Couscous o Borlotti � Corn � Crambe o Broad ° Blue � Cuphea o Butter ° Dent � Edamame o Cannellini ° Flint � Farina o Ceci ° Flour � Farro o Christmas Lima ° High-Oil � Flax o Cranberry ° Polenta � Flaxseed o Fava ° Popcorn � Job’s Tears o Flageolet ° White � Kadalai Paruppu o Garbanzo ° Yellow � Kadale Belle o Great Northern ° Sweet � Kamut o Horse ° White � Kanihuaco o Kidney ° Yellow � Kaniwa o Lentil � Kasha � Khorasan o Madagascar � Lovegrass � Meadowfoam o Navy � Millet � Mustard o Red ° Dent � Oats o Red Kidney ° Flint � Olives o Roasted Soybean ° Flour � Pea o Scarlet Runner ° Proso ° Black-Eyed Pea o Small Red ° Ragi ° Chickpea o Soy Nut � Peanuts ° Pigon o Soybean � Pennycress � Proso Millet o Edible � Quinoa � Rapeseed o Spanish ° Inca Red � Safflower o Teff ° Traditional � Sesame o Turtle � Rye � Sooji o Venezuelan � Sorghum � Spelt o Yankee � Sugar Beet � Sunflower

� Rice � Tampico Bean � Teff o Brown � Triticale � Ulutham Paruppu o White � Urad Dal o Wild


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Grain Product Type (continued): � Wheat � Other:_______________________________________

o Durum o Hard Red Spring o Hard Red Winter o Hard White o Kamut o Red o Soft Red Winter o Soft White o Spelt o White


� Gluten-Free � GMO Free � No Preservatives � Pesticide Free � Source-Verified � Sustainable Practices � Wild Harvest � Other:_______________________________________


� Free of noxious weed seed � GAP Certified (Standards) � Halal Certified � Identity Preserved � Kosher Certified � Natural � Organic (certified) � Pre Variety Germplasm (Native Plant Connection) � State Environmental Certification � Quality Assurance � Other _______________

Product Forms

� Bagged/Packaged � Bran � Bulk-dry � Dehydrated � Dried � Extract � Flour � Freeze-Dried � Fresh � Germ � Grain Flakes � Grits � Ground/Milled � Meal � Oil Extract � Pearled Grains � Prepared/Fresh � Prepared/Packaged � Vacuum-Packed � Whole Grains � Other:_________________________________________________________________


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Grain Product Type (continued):

Methods of Sale

� Community Supported Agriculture � Debit/Credit Cards � Delivery � EBT/SNAP � Export � Farm-to-School � Farmers Market � Internet � Mail Order � On-Farm-Sales � Pick-Your-Own � Retail Storefront � Roadside Stand � Wholesale � WIC � Other:__________________________________________________________________


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Herb Product Type

� Angelica � Basil � Bay Laurel � Catnip � Chives � Cilantro � Coriander � Dill � Fennel � Goldenseal � Lavender � Lemon Balm � Marjoram � Mint � Mustard � Oregano � Parsley � Rosemary � Rue � Sage � Savory (winter) � Stevia � Tarragon (true) � Thyme � Verbena (lemon) � Other:_______________________________________


� GMO Free � Hoop House/High Tunnel � Kosher � Natural � No Artificial Colors � No Artificial Flavors � No MSG � No Preservatives � Pesticide Free � Source-Verified � Sustainable Practices � Wild Harvest � Other:__________________________________________________________________


� GAP Certified (Standards) � Halal Certified � Kosher Certified � Natural � Organic (Certified) � State Environmental Certification � Other:__________________________________________________________________

Product Forms

� Dehydrated � Dried � Extract � Freeze-Dried � Fresh � Fresh Processed/Packaged � Frozen � Ground � Plants for Sale � Prepared/Packaged � Stone-Ground � Vacuum-Packaged � Other:__________________________________________________________________


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Herb Product Type (continued):

Methods of Sale

� Community Supported Agriculture � Debit/Credit Cards � Delivery � EBT/SNAP � Export � Farm-to-School � Farmers Market � Internet � Mail Order � On-Farm-Sales � Pick-Your-Own � Retail Storefront � Roadside Stand � Wholesale � WIC � Other:__________________________________________________________________


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Meat and Poultry Types:

� Alligator � Beef � Buffalo � Chicken � Cornish Hens � Deer/Venison � Duck � Eggs � Elk � Emu � Geese � Goat � Lamb/Sheep � Llama � Osterich � Pheasant � Pork � Quail � Rabbit � Squab � Turkey � Veal � Other:_______________________________________


� Free Range � GMO Feed Free � Low Fat � Naturally Processed � No Antibiotics Ever � No Antibiotics Fed � No Artificial Colors � No Artificial Flavors � No Growth Promotants � No Ionophore � No Preservatives � Pasture/Grass Fed � Source-Verified � Sustainable Practices � Other:__________________________________________________________________


� Certified Humane Care � FDA Inspected � GAP Certified (Standards) � Grass Fed � Halal Certified � Kosher Certified � Natural � Organic (Certified) � Quality Assurance � Source-Verified � State Inspected � State Environmental Certification � USDA Inspected � Other:_______________________________________

Product Forms

� Canned � Cured � Dried � Fresh � Frozen � Lard � Live � Prepared/Frozen � Prepared/Packaged � Smoked � Vacuum-Packed � Other:__________________________________________________________________


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Meat and Poultry Types (continued):

Methods of Sale

� Community Supported Agriculture � Debit/Credit Cards � Delivery � EBT/SNAP � Export � Farm-to-School � Farmers Market � Internet � Mail Order � On-Farm-Sales � Pick-Your-Own � Retail Storefront � Roadside Stand � Wholesale � WIC � Other:_________________________________________________________________


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Specialty Products

� Cane Syrup � Edible Flowers � Honey � Hops � Maple Syrup � Sugar Cane � Wheatgrass � Other:_______________________________________


� Calcium Fortified � High Fiber � Hoop House/High Tunnel � Low Carb � Low Cholesterol � Low or Fat Free � No Artificial Colors � No Artificial Flavors � No Preservatives � No Sugar Added � Source-Verified � Sustainable Practices � Wild Harvest � Other:_______________________________________


� GAP Certified (Standards) � Halal Certified � Kosher Certified � Natural � Organic Certified � State Environmental Certification � Other:__________________________________________________________________

Product Forms

� Bottled � Canned � Condiments � Dehydrated � Dried � Fresh � Pasteurized � Prepared/Fresh � Prepared/Packaged � Unpasteurized � Other:_______________________________________

Methods of Sale



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Vegetable Product Types

� Artichokes � Arugula � Asparagus � Beans � Beets � Bok Choy

o Lima � Broccoli � Brussel Sprouts o Pole � Cabbage � Carrots o Runner � Cauliflower � Celery o Snap � Chard � Chicories o Wax ° Swiss � Collards o Yellow � Corn � Edamame Soybeans

� Cucumbers ° Indian � Eggplant o Burpless ° Sweet � Endive o Gherkin � Garlic � Gourds o Greenhouse � Greens � Horseradish o Pickle ° Mustard � Kale o Slicing ° Turnip � Kohlrabi

� Leeks � Lettuce � Mirlitons � Okra ° Head � Onions � Parsnip ° Leaf ° Green � Peas ° Romaine ° Sweet

o English � Potatoes ° Vidalia o Southern � Pumpkins � Radishes

� Mushrooms � Peppers � Rhubarb o Button ° Banana � Rutabagas o Crimini ° Bell � Salsify o Maitake ° Hot � Scallions o Portabella � Shallots � Spinach o Shiitake � Sweet Potatoes � Tomatillios


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Vegetable Product Types (continued):

� Sprouts � Squash � Tomatoes o Alfalfa ° Summer � Turnips o Bean ° Winter � Zucchini o Broccoli o Buckwheat o Fenugreek o Garlic o Green-Leaf o Lentil o Pumpkin o Radish o Snow Pea o Sunflower o Wheat � Other:__________________________________________________________________

Producer Attributes—Producer Verified

� Calcium-Fortified � GMO Free � Greenhouse � Hoop House/High Tunnel � Hydroponic � Iron-Fortified � Kosher � Lite � No Artificial Colors � No Artificial Flavors � No Preservatives � Pesticide Free � Source-Verified � Sustainable Practices � Wild Harvest � Other:__________________________________________________________________

Product Attributes-3rd Party Certified/Verified

� GAP Certified (Standards) � Halal Certified � Kosher Certified � Natural � Organic (Certified) � State Environmental Certifications

� Other:__________________________________________________________________


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Vegetable Product Types (continued):

Product Form

� Bottled � Canned � Condiments � Dehydrated � Dressings � Dried � Forced-Air Cooled � Freeze-Dried � Fresh � Fresh Processed/Packaged � Frozen � Hydro-Cooled � Individually Quick Frozen � Juice � Oil � Pasteurized � Pickled � Prepared/Frozen � Salsa � Sauces � Unpasteurized � Vacuum-packed � Other:_______________________________________

Methods of Sale



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Freshwater Fish/Shellfish

� Baitfish � Bass � Bluegill o Central Mudminnow ° Black ° Hybrid o Creek Chub ° Hybrid Striped � Carp o Dace ° Largemouth ° Common o Emerald Shiner ° Smallmouth ° Grass o Fathead Minnow � Catfish � Chubs o Golden Shiner ° Blue � Clams o Goldfish ° Channel � Crawfish o Green Sunfish ° Flathead � Drum, Freshwater o Hornyhead Chub ° Hybrid � Escargot o Spotfin Shiner � Frog Legs � Gars o White Sucker � Ornamental Fish � Paddlefish

� Perch � Prawn � Suckers o Yellow ° Freshwater � Smelt

� Salmon � Sunfish � Tilapia o Atlantic � Walleye � Whitefish, Lake o Coho

� Trout � Other:_________________________________ o Brook o Brown o Lake o Rainbow


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Marine Fish/Shellfish/Seafood

� Amberjack � Anchovy, Northern � Argentine o Greater � Atka Mackerel � Barracuda o Lesser � Barrelfish ° Atlantic

� Bass � Bluefish ° Pacific o Striped � Bonito � Bowfin

� Brotula, Bearded ° Atlantic � Butterfish � Cabezon ° Pacific � Clam � Cobia � Cockle � Cod � Crab ° Nuttall ° Atlantic

o Atlantic Rock � Grenadier ° Pacific o Blue � Grouper � Grunt o Blue Peeler ° Black � Haddock o Blue, Soft ° Gag � Hagfish o Deepsea Golden ° Red � Hake o Dungeness ° Scamp ° Offshore Silver o Florida Stone Claws ° Snowy ° Pacific (Whiting) o Johah ° Warsaw ° Red o King ° Yellowedge ° Silver o Red Rock � Halibut ° White o Snow ° Atlantic � Harvestfish o Southern Tanner ° California � Herring

� Hind ° Greenland � Hogfish o Red ° Pacific � Jack o Rock � Jack Mackerel ° Almaco o Speckled � Jobfish, Green (Uku) ° Bar

� King Whiting � Lingcod ° Crevalle � Oyster � Lobster � Parrotfish

o Eastern ° American � Perch o European Flat ° California Spiny ° White o Pacific ° Caribbean Spiny ° Yellow

� Pinfish � Pollock � Pomfret o Spottail ° Walleye � Pompano, Florida

� Redfish, Acadian � Porgy � Sheephead, California � Shad

o Knobbed � Sheepshead ° American o Red � Skate ° Hickory o Whitebone � Skipper � Smelt


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Marine Fish/Shellfish/Seafood (continued):

� Rockfish � Shark � Shrimp o Bank ° Atlantic Sharpnose ° Brown o Black ° Bigeye Thresher ° Ocean o Black-and-Yellow ° Blacknose ° Pacific Rock o Blackgill ° Blacktip ° Pink o Blue ° Bonnethead ° Rock o Bocaccio ° Bull ° Royal Red o Brown ° Finetooth ° Seabob o Canary ° Hammerhead ° Spot o Chilipepper ° Lemon ° White o Chopper ° Leopard � Snapper o Darkblotched ° Makos ° Gray o Gopher ° Pacific Angel ° Lane o Grass ° Sandbar ° Mutton o Pacific Ocean Perch ° Shortfin Mako ° Queen o Splitnose ° Smooth Dogfish ° Red o Vermilion ° Soupfin ° Silk o Widow ° Spinner ° Vermilion o Yelloweye ° Spiny Dogfish ° Yellowtail o Yellowtail ° Thresher � Cusk

� Cutlassfish, Atlantic ° Tiger � Croaker

o Atlantic � Dory (American John) � Drum o Pacific White � Eel ° Black

� Escolar ° American ° Red � Gar ° Conger ° Goatfish � Goosefish � Greenling, Kelp � Permit � Flounder � Pigfish � Lookdown

o Arrowtooth � Mahi Mahi/Dolphinfish � Margate o Atlantic, Plaice � Marlin � Mojarra o Fourspot ° Blue � Monk Fish o Pacific, Sanddab ° Striped � Moonfish, Atlantic o Southern � Mullet � Mussel o Starry ° Striped (Liza) ° Blue o Summer ° White � Octopus o Winter � Oilfish � Opah o Witch � Crawfish � Rosefish, Blackbelly o Yellowtail � Rudderfish, Banded � Runner, Blue


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Marine Fish/Shellfish/Seafood (continued):

� Mackerel � Stablefish � Sailfish o Atlantic � Salmon � Sardine o Cero ° Chinook ° Pacific o Chub ° Chum ° Spanish o King ° Coho � Scad o Spanish ° Pink ° Bigeye

� Scallop ° Sockeye ° Mackerel o Bay � Sculpin � Sea Bass o Sea � Sea Catfish ° Black o Weathervane � Sea Chub ° White

� Sea Cucumber � Sea Urchin � Seaweed � Spadefish � Spearfish � Spot � Sole � Seatrout � Squid

o Dover ° Sand ° California Market o English ° Spotted ° Longfin o Flathead � Squirrelfish ° Northern Shortfin o Petrale � Sturgeon, White ° Robust Clubhook o Rex � Surfperch � Surgeonfish o Rock � Swordfish � Tautog o Sand � Thornyhead, Shortspine � Tilefish o Yellowfin � Triggerfish ° Blueline

� Tuna ° Gray ° Golden o Albacore � Wahoo � Weakfish o Bigeye � Whelk � Wolfish, Atlantic o Blackfin ° Channeled � Yellowtail Jack o Bluefin ° Knobbed o Bluefin Pacific � Other:_________________________________ o Little Tunny o Skipjack o Yellowfin


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Freshwater and Marine Fish/Shellfish/Seafood (continued):

Producer Attributes—Producer Verified

� All Natural � Chemical Free � Farm Raised � GMO Feed Free � Hormone Free � Live � Low Sodium � No Antibiotics Ever � No Antibiotics Fed � No Artificial Colors � No Artificial Flavors � No Growth Promotants � No MSG � No Preservative � Processed under HACCP � Source Verified � Sushi-grade � Trap-Caught � Troll-Caught � Troll-Caught � Wild Harvest/Caught � Other:__________________________________________________________________

Product Attributes-3rd Party Certified Verified

� County or State Inspected � FDA Inspected � GAP Certified (Standards) � Global Aquaculture Alliance � Kosher � Marine Stewardship Council � Source-Verified � USDC Inspected Certified � State Environmental Certification � Other:_________________________________

Product Forms

� Bushels � Canned � Caviar � Cured � Dehydrated � Dog/Cat Treats � Dried � Dry Packed � Fillets � Fish Fins � Fish Meal � Fish Skin � Flaked Fish � Freeze-Dried � Fresh � Fresh-Never Frozen � Frozen � Frozen, Block � Frozen, IQF � Head-Off � Head-On � Live � Oil � Peeled & Deveined � Pickled � Pre-packaged Portions � Salads/Spreads � Salted � Smoked � Unpasteurized � Vacuum-packed � Value-Added � Whole Dressed/Deheaded � Whole Dressed/Head-On � Other:_______________________________________


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Freshwater and Marine Fish/Shellfish/Seafood (continued):

Methods of Sale


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