Maine Center for Disease Control & Prevention
A Division of the Maine Department of Health and Human Services
Use this form to change the information about your farm stand or other market for locally grown products.
By typing my name in the signature field and submitting this electronic form, I certify that the information on this form is correct. I certify that 75% or more of my product offered for sale is grown by me or under my direction and that product not grown by me has been purchased from another Maine farmer.
I understand that any false statements made in connection with this application may be grounds for denial of the application or termination of the location as an authorized WIC vendor.
I understand that qualified interpreters are available at no cost to me.
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