SNAP Application

Market Physical Location
Market Name:
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:
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:

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.