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Section 1 - Farm Business Information
* Application Typesemi_colon New Application1 Renewal Application
Registration Number1semi_colon NB
* Ownership Typesemi_colon Sole Proprietorship
Partnership
Corporation
* Business Name1semi_colon
* Owner's Namesemi_colon
* Business Numbersemi_colon
* StreetPO Boxsemi_colon
* City, Town or Villagesemi_colon
* Provincesemi_colon
* Postal Codesemi_colon
* Telephone Numbersemi_colon
Fax Numbersemi_colon
* EMailsemi_colon
Section 2 - Contact Person
* Namesemi_colon
* Relationship to Farm Businesssemi_colon
* Language preferencesemi_colon English French
  StreetPOBoxsemi_colon
  City, Town or Villagesemi_colon
  Provincesemi_colon
  Postal Codesemi_colon
  Telephone Numbersemi_colon
Fax Numbersemi_colon
EMailsemi_colon
Section 3 - Registration Eligibility
* Agricultural producers operating
Tillage of soil (crops)
     Potato
     Vegetable
     Hay
     Grain
     Other    
 Raising or exhibiting of livestock
     Beef
     Sheep
     Pork
     Goat
     Other    
 Dairy farming
Raising of poultry Fruit growing Fur farming
Keeping of bees Maintenance of horses (racing/exhibiting) Mechanical hatching operation
Nursery/greenhouse Tree farming (Christmas trees, maple syrup) Start-up operation
Section 4 - Payment
Please select the appropriate box
(Check one) Annual Gross Farm Income Registration Fee
$1 - $49,999 $165
$50,000 - $149,999 $250
$150,000 - $249,999 $360
$250,000 - $499,999 $440
$500,000 - $749,999 $550
$750,000 or more $675
Section 5 - Membership Information
* Please indicate your preference
I wish to be a member of the Agriculture Alliance
I wish to be a member of the National Farmers
I wish to be a member of both
G.F.O. Web address Toll free number
Agricultural Alliance of New Brunswick www.fermenbfarm.ca/ 1-888-826-4522     506-452-8101
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National Farmers Union in New Brunswick www.nfu.ca/ 506-260-0087
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Section 6 - Farmer Purchaser Permit
* I wish to apply for a Farmer Purchaser's Permit
Yes
No
(The attached Farmer Purchaser's Permit Annual Rep
Section 6 - Declaration
With submission of payment
* Name * Date (js_YMD)
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