First name

Last name

Phone number

Your email

Business Name (If applicable)

City, State

What services do you provide?

What is your average or requested cotton order quantity?

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First name

Last name

Phone number

Your email

Land Address

Land City, State

Land Acres

Has your land been farmed on in the last 1-3 years?
YesNo

If so, what crops?

Does your land border any farms?
YesNo

Are you interested in farming your land?
Manage my own farmJoin, partner and allow B.L.A.C.Kollective to grow on land

Do you have any experience with cotton or farming?
YesNo

What experience do you have with cotton/farming? (optional)

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First name

Last name

Farm name (If applicable)

Phone number

Your email

Farm Address

Farm City, State

Farm Acres

Are you currently using any climate-beneficial practices? This is not required; practices include: composting/cover crops/companion crops/ no-till or strip-till/ water harvesting/etc.
YesNo

What crops are you currently growing?

Do you have any experience with cotton?
YesNo

What experience do you have with cotton? (optional)

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First name

Last name

Farm name (If applicable)

Phone number

Your email

Farm Address

Farm City, State

Farm Acres

What cotton variety/s do you grow?

How many acres of cotton are you growing?

Are you currently using any climate-beneficial practices? This is not required; practices include: composting/cover crops/companion crops/ no-till or strip-till/ water harvesting/etc.
YesNo

Are you growing any other crops?
YesNo

What other crops are you currently growing?

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First name

Last name

Farm name

Number of farmers (Farm Orgs/Co-ops Only)

Phone number

Your email

Farm Address

Farm City, State

Farm Acres

Are you currently using any climate-beneficial practices? This is not required; practices include: composting/cover crops/companion crops/ no-till or strip-till/ water harvesting/etc. (optional)
YesNo

What are you currently growing? (optional)

Do you understand this program?
YesNo

Questions? (optional)

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