Produce Perks New Market Application
Thank you for your interest in Produce Perks. This form is for Market Manager or site owners only. If you are a customer, please use the Market Locator Tool to find the closest market to you that offers the Produce Perks match: https://produceperks.org/locations/

To help us better understand your market, please answer as many of the following questions as possible. All information provided will be kept confidential.

Contact Name *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Site (market, store) Name *
Your answer
Location Address
Your answer
Mailing Address *
Your answer
What year did your site become authorized to accept SNAP? (Leave blank if you do not accept SNAP at this time)
MM
/
DD
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YYYY
What is your FNS number? (If applicable)
Your answer
Do you use tokens or paper scrip to represent SNAP dollars at your site?
What were your SNAP sales ($) for the previous calendar year? (If applicable)
Your answer
What year did your site begin operating?
Your answer
Do you currently, or have you in the past, offered an incentive program? *
If so, what year did you begin offering incentives?
Your answer
Do you have current/potential funding for a matching incentive?
Do you offer any nutrition education or onsite resources for customers? If so, what kinds?
Your answer
Is your site a: *
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