Click here for a printable pdf Certified Local_application

Date___________________ Location(s)_____________________

Name of Restaurant_______________________________________________________________

Owner________________________________ Chef__________________________________

Capacity________________________________

Address_________________________________________________________________________

Telephone____________________Email_______________________________________________

Brief Description of facility__________________________________________________________

Information from applicant:

Please describe your purposes and motivation for sourcing locally.

What is the major benefit that you perceive of buying locally?

Member of NH Made______      Member NH Lodging and Restaurant Association______

Please list your sources and the products from each:

Farm /Source                      Contact Information                                      Product

Briefly describe your level of commitment to buying from NH growers and producers.

Do you communicate this commitment to staff and clients? How is this done?

How has buying local New Hampshire farm products impacted your business?

What is the main challenge to purchasing locally?

What products would you purchase locally but find unavailable?

Would you be interested in working with farmers so that crops or livestock are raised specifically for your restaurant?

Other comments:

Agreements:

By submitting this application, it is understood that the applicant:

Agrees to accept the results of the evaluation by the NHFRC‘s “Certified Local” program.

Agrees that Certification is not transferable and will cease upon sale of the business

Agrees to list New Hampshire farms and other local sources where the restaurant purchases NH agricultural products, to request these sources to cooperate with the NHFRC in confirming these relationships, and to update the NHFRC when regular sources are either added or no longer used.

Agrees upon certification, to permit periodic review of your restaurant and verification of sources at the discretion of the NHFRC.

Agrees to allow listing of the restaurant on our marketing materials, web site, social media and partners’ web sites (e.g. NH Travel and Tourism).

Agrees to promote New Hampshire farms and agricultural products to employees and the public.

Fee:

$ 35 Single Site

$ 75 Up to Three Sites

$ 150 Multi-Site

Please submit payment as a check or money order.  Fees are to cover administrative costs of the certification program.

Please mail to: NHFRC, c/o Charlie Burke, PO Box 68, Sanbornton, NH 03269

Signature__________________________Date__________

Printed Name_____________________________________

Printable pdf   Certified Local_application