Producer | Processor

Name of Producer Phone Email Web site USU Extension agent for your production area Contact Name Phone Email Operation location City Zip	Does your business file a tax return with the State of Utah? Yes | No Party who can verify your agricultural production Name Address City Zip Phone Email Mailing Address City Zip
The Utah Department of Agriculture and Food only registers products for the use of the Utah's Own logo. The greater part of the value of the product must be derived within the State of Utah. Please provide the following product information including how the product meets Utah's high quality standards.
Name of Product Quantity Produced       Organic Natural Conventional Organic Natural Conventional Organic Natural Conventional Organic Natural Conventional Organic Natural Conventional Organic Natural Conventional
As a Utah producer, I attest that the information provided is correct to the best of my knowledge. I further agree to notify the Marketing Division of the Utah Department of Agriculture and Food of any change in farming status that would affect my grower registration.
Type your name Title Date