PICK-UP REQUEST FORM
Once this intake form is complete you will be invited to schedule a pick-up.
Email address *
HSGG Farm ID #
Your answer
Farm/Business Name *
Your answer
Licensed Address (Line 1) *
Your answer
Licensed Address (City, State, ZIP) *
Your answer
Contact Name *
Your answer
Phone number
Your answer
License # *
Your answer
License Type *
Your answer
License Expiration Date
MM
/
DD
/
YYYY
Requested Pick-up Date
MM
/
DD
/
YYYY
Next
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