Business & Organization Registration UsernameName First Last Account Email* Enter Email Confirm Email Password* Enter Password Confirm Password Business Owner InformationWhat Type Of Business Are You?-- select a Category --Artisan Food ProducersCaterersCommunity Supported AgricultureDistributorsFarm & Farm Based BusinessFarm StandsFarmers MarketsGrocery & RetailPick Your OwnRestaurantsSupporting OrganizationsWholesaleNameTitlePhoneEmail Business AddressStreet AddressCityZip CodeCountyAlamanceAlexanderAlleghanyAnsonAsheAveryBeaufortBertieBladenBrunswickBuncombeBurkeCabarrusCaldwellCamdenCarteretCaswellCatawbaChathamCherokeeChowanClayClevelandColumbusCravenCumberlandCurrituckDareDavidsonDavieDuplinDurhamEdgecombeForsythFranklinGastonGatesGrahamGranvilleGreeneGuilfordHalifaxHarnettHaywoodHendersonHertfordHokeHydeIredellJacksonJohnstonJonesLeeLenoirLincolnMcDowellMaconMadisonMartinMecklenburgMitchellMontgomeryMooreNashNew HanoverNorthamptonOnslowOrangePamlicoPasquotankPenderPerquimansPersonPittPolkRandolphRichmondRobesonRockinghamRowanRutherfordSampsonScotlandStanlyStokesSurrySwainTransylvaniaTyrrellUnionVanceWakeWarrenWashingtonWataugaWayneWilkesWilsonYadkinYanceyGeneral InformationBusiness Name* Website PhotoDescriptionPracticesPractices (if applicable) Animal Welfare Approved Biodynamic Certified Naturally Grown Conventional Free Range GMO free Humanely Raised Integrated Pest Management Low Spray Organic (NOP Certified) Organic (not certified) Pasture Raised Permaculture Wild Harvested Vendors (if applicable)Approximate number of vendors on market day:Approximate number of total vendors:CertificationThe Piedmont Grown label is a certification mark. To protect the integrity of the label and the local food market, all businesses must meet specific standards and sign the licensee agreement. Please agree to the terms below by selecting each check box and selecting the Save or Save and Continue buttons.I attest that the below statements about my business are true, that I have read and agree to the terms in the Licensing Agreement, and that I agree to follow the stated guidelines should I choose to use the Piedmont Grown logo.*YesNoTotal product by weight—excluding sugar, water, salt, oil, and wheat—must be 75% local ingredients from certified Piedmont Grown farms.* Agree Total product by weight—including all ingredients—must be 40% local ingredients from certified Piedmont Grown farms.* Agree No single product ingredient can come from a mixture of local and non-local sources. For example, a jar of salsa cannot use a combination of Piedmont Grown tomatoes and tomatoes from a non-local source.* Agree Package 2Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name Total $0.00 This iframe contains the logic required to handle Ajax powered Gravity Forms.