APPLICATION FOR REGISTRATION AS TOMATO HANDLER |

APPLICATION FOR REGISTRATION AS TOMATO HANDLER (FTC-102-75)

"*" indicates required fields

I hereby apply for registration as a Tomato Handler for the - season. Each handler who handles tomatoes grown in the production area must be certified as a registered handler by the Committee in order to ship such tomatoes outside of the regulated area. A handler who is certified as a registered handler is a handler who has adequate facilities to meet the requirements of preparing tomatoes for market, obtains inspection on tomatoes handled, agrees to handle tomatoes in compliance with the marketing order’s grade, size and container requirements, pays applicable assessments on a timely basis, submits reports required by the Committee, and agrees to comply with other regulatory requirements on the handling of tomatoes grown in the production area. The Committee or its authorized agent shall inspect a handler’s facilities to determine if the facilities are adequate for preparing tomatoes for market. In order to be adequate for such purposes, the facilities must be permanent, non-portable buildings located in the production area with equipment that is non-portable for proper washing, grading, sizing and packing of tomatoes grown in the production area.

1. Company/individual address of all location(s) of grading and packing facilities in the production area:*

2. Type of business (Individual, Firm, Partnership, Corporation, Co-operative, Association or other business unit):*

3. If other than individual, show below names and addresses of the officers, partners, or other individuals having a financial interest in the business with the applicant.*

Name

Title

Address, City, State, Zip code

4. How many years have you been in the tomato business in Florida?*

Business Name of Applicant:*

Street Address:*

Street Address Address Line 2 City State ZIP Code

Mailing Address:*

Street Address Address Line 2 City State ZIP Code

Telephone Number:*

Fax Number:

Email address:*

By:*

Authorized Signature

Print Name:*

Print Name

Title:*

Title

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0581- 0178. The time required to complete this information collection is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

CRITICAL INFORMATION REQUEST

Please provide the information below for each grower who you expect will be shipping through your packing facility for the - season. This information is needed to ensure that your growers are kept up-to-date on Florida Tomato Committee (Committee) activities and on subjects affecting the Florida tomato industry as a whole, such as: Medfly alerts; government regulations; labor situations; market conditions; etc.

GROWER NAME

CONTACT NAME

ADDRESS, CITY, STATE, ZIP CODE

TEL. NO.

EMAIL:

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.

Name

This field is for validation purposes and should be left unchanged.

FTC-102-75 (Exp. 3/31/2024)

OMB No. 0581-0178