SNAP Application Market Physical Location Market Name: Address: City: County: State: Zip Code: Market Operation: Days, Hours, Average Number of Vendors at Height of Season Example: Mondays 8-2, 70 vendors, Wednesdays 9-3, 40 vendors Market Manager: SNAP Coordinator: Telephone: Email: Specific Site Details 1. Number of households in your area (specify County or City) receiving Food Stamps:: Please check with your County Human Services office for accurate information. 2. Length of time your market has been in operation:: 3. Gross sales estimate of market in 2013: This information is confidential and is also required for FNS Retail Authorization Application 3a. Gross Sales of SNAP in 2013: 3b. Number of SNAP coupons needed in 2014 ($ amount): 3c. Number of Market Buck coupons needed for 2014 season ($ amount): 4. Does your market site have access to electricity?: Yes No 5. Does your market have access to a landline telephone?: Yes No 6. Other food aid programs in which your market participates? (WIC, Senior Farmers Market Nutrition Program, food donations, etc.): 7. Would you be interested in accepting Debit and Credit Cards along with SNAP?: Debit Credit 8. Please write a paragraph about why your market would be interested in hosting CFMA SNAP: Verify 1+1=? Notes: 1.) One check may be made out (payable to CFMA) for the total amount of membership dues and insurance fee. 2.) Membership dues and insurance fees are non-refundable.