Agricultural Farm Application

Agricultural Farm Application

WHEREAS

WHEREAS, Applicant represents that Applicant operates or will operate an agricultural production enterprise located at the Farm Location declared below and seeks consideration for program resources, assistance, permits, or agreements offered by the Administrator;

WHEREAS, Administrator administers programs, financial assistance, technical support, or land-use approvals and requires accurate farm, ownership, environmental and production information and agreement to the terms and conditions set forth herein as a condition of participation;

NOW, THEREFORE, Applicant submits this Agricultural Farm Application and agrees to the representations, certifications and program terms contained in this document, which will form the operative agreement between Applicant and Administrator upon acceptance.

Applicant Information

Entity Type: Individual Partnership Corporation LLC Cooperative Other

Farm Details

County:    Total Acreage:    Tillable Acres:

Organic Certified: Yes    Certificate No.:

Land Tenure: Owned Leased Sharecropped

Lease Term Start:    Lease Term End:

Requested Assistance

Financial Assistance / Grant Technical Assistance Permit / Land-Use Approval Equipment Support

Anticipated Project Start:    Anticipated Completion:

Program Terms — Payment, Term and Confidentiality

Scope of Work

Payment Terms

Payment Amount / Budgeted Assistance:

Late Payment Fee (if applicable):

Term and Termination

Agreement Term Start:    Agreement Term End:

Confidentiality

Applicant and Administrator shall each keep confidential and shall not disclose to third parties any information designated in writing as confidential or that reasonably should be understood to be confidential given its nature and the circumstances of disclosure, except to the extent disclosure is required by law or necessary to perform obligations under this application and any resulting agreement. Confidential information shall be used solely for purposes of evaluating and implementing the scope of work and assistance described herein.

Governing Law

This Application, any acceptance hereof, and any resulting agreement shall be governed by and construed in accordance with the laws of the State indicated below without regard to conflict-of-law principles.

Entire Agreement

This Application, together with any schedules, attachments or written agreements accepted by Administrator, constitutes the entire agreement between Applicant and Administrator with respect to the subject matter hereof and supersedes all prior written or oral communications, representations and proposals. Any modification must be in writing and signed by both parties.

Certifications and Authorizations

Applicant certifies that the information in this Application is true, complete and accurate to the best of Applicant's knowledge. Applicant authorizes Administrator and its agents to verify the information provided, to request supporting documentation, and to perform site inspections as necessary to evaluate eligibility. Applicant acknowledges that false statements or material omissions may result in denial of assistance, repayment obligations, or other remedies available to Administrator under law.

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