Potluck Food Co-op Producer Questionnaire
Name of Business *
Your answer
Contact Person *
Your answer
Member Number (if applicable)
Your answer
E-mail Address *
Your answer
Phone Number *
Your answer
Website
Your answer
Street Address / Rural Route *
Your answer
City *
Your answer
Territory / Province *
Your answer
Postal code *
Your answer
What is the best way to reach you? *
What type(s) of product do you sell? *
Required
What do you typically have available, and when do you have it? *
Your answer
Shelving requirements for your products *
Required
What is your current pricing structure / price list? *
Your answer
Do you adhere to all Canada GAP policies? (For produce only) *
What certifications do you currently hold?
Base on our Producer Policy, what term would you associate with yourself most? *
If you picked "Sustainable", please describe the practices you use
Your answer
Any additional information you want us to have?
Your answer
Please send all relevant certificates, licenses, and permits to the Potluck team at info@potluckcoop.com
Have you read the Potluck Food Co-op Producer Policy? *
The Co-op will consider false statements on the Producer Questionnaire about the origin or production standards of products listed to constitute fraud. To protect the integrity of our marketing system, the cooperative reserves the right to verify the claims of everything sold through our online ordering system. *
Required
Feedback on this form and process: How can we improve?
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