Producer Application (please print, complete information, return with cheque by mail)

PERSONAL INFORMATION
FARM NAME
 
FIRST NAME
 		 LAST NAME
 
MAILING ADDRESS
 
CITY
 		 PROVINCE
 		 POSTAL CODE
 
HOME PHONE
 		 HOME FAX
 		 CELL
 
EMAIL
 		 WORK
 		 ALTERNATIVE
 
CWB PERMIT BOOK #  
GRAIN FOR SALE (now or in future)
GRAIN TYPE &
VARIETY		 WEIGHT MST PRT QTY TARGET
PRICE		 OTHER
COMMENTS
Barley              
Wheat              
Oats              
Peas Green              
Peas Yellow              
Rye              
Flax              
Triticale              
Canola              
Other              
TRANSPORTATION
□I prefer to haul my own grain. Amount of tonnage I can haul is:
 		 □I prefer to have my grain picked up in the yard. My preferred hauler is:
 
MEMBERSHIP
□ Yes, please sign me up for a membership. Enclosed is a cheque for $110.00 +GST for 50 issues.
 		 Below is my preferred password:
I understand membership DOES NOT include brokerage fees for the marketing of any grain. Brokerage fees are $0.06/bu, payable to Market Master Ltd., and due 15 days from the date of invoice.
DATE
 		 Make cheque payable to:

Market Master Ltd.
8543 - 75 Avenue
Edmonton, Alberta  T6C 0G9
SIGNATURE