Michigan Produce Safety Farm Survey

Please complete the following information to help determine your coverage status under the Produce Safety Rule.

Question Title

* 1. Farm/Business Information
If you do not have a phone number or email address, please indicate an alternate means of communication in the phone and email fields below.

Farm or Business Name:

Address:

City:

ZIP:

Phone Number:

Email Address:

Question Title

* 2. Farm/Business Preferred Point of Contact

First Name:

Last Name:

Job Title:

Phone Number:

Email: