Mandela Produce Distribution - New Wholesale Customer Intake Form

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Mandela Produce Distribution - New Wholesale Customer Intake Form

Thank you for your interesting in buying wholesale produce with Mandela Produce Distribution! MPD is a program of Mandela Partners, and a community food hub based in West Oakland that increases access to local, sustainably-grown fresh produce, while supporting the economic success of small-scale BIPOC farmers. This form will provide us with a brief introduction/background on you and your business. We will follow up with you to discuss your produce needs as soon as possible!

What is the name of your business? *

What is your name and role in your business? *

How long have you been in business? *

Phone Number:
*

Email: *

What is your preferred method of being contacted? *

Phone

Text

No preference

Required

Business Address:
*

Business Website URL (if applicable)

Social Media Handles:

What kind of business do you operate?
(Check all that apply) *

Restaurant

Catering

Meal Delivery

Corner Store

Grocery Store

Other:

Required

Please check any of the following that apply to you and your business:

Legacy Business (Long-standing independent business that is an important part of a community's history, identity, and culture.)

Social Enterprise (A social enterprise uses methods to address social or environmental issues while making a profit. They often focus on improving the living conditions of marginalized or disadvantaged groups.)

Cooperatively-Owned

LGBTQIA - Owned

BIPOC - Owned

Family-Owned

Immigrant - Owned

Other:

Is there anything else you would like to share about you or your business?

Submit

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