Food association

2017 MotherLode Harvest Registration

IMPORTANT INSTRUCTIONS: Fill out the form below to obtain a UserID and Password to access our on-line ordering system. Our producer/customer association has specific membership requirements which are outlined in the our Customer Policies. Please read it, then print, fill out and sign the Customer Agreement, in addition to submitting the on-line form below. You may either mail the Agreement and Membership fees to Mother Lode Harvest, P.O. Box 534 Amador City, CA 95601 or bring the completed forms and membership dues when you pick up your first order.


Thank you for your interest in shopping with MotherLode Harvest. MotherLode Harvest customers and producers are interested in local foods and products produced with sustainable practices that demonstrate good stewardship of the environment. To get a User ID and password, please complete the following information and click submit.

If you are already registered, please sign in here. Otherwise fill out the form below.

Section 1: General Information
First Name: Last Name:
First Name 2: Last Name 2:
Business Name:
Section 2: Contact Information
Address:
Address 2:
City/State/Zip:  
County: Do Not Send Postal Mail:
Work Address:
Work Address 2:
City/State/Zip:
Home Phone: Work Phone:
Mobile Phone: FAX:
Toll Free:    
Email Address:
Email Address 2:
Home Page: http://
Section 3: Access Credentials
Username: Enter the word
Human validation text
Human validation text
Password:
Confirm:
Section 4: Additional Information
How you heard about MotherLode Harvest:
Please give more detail:
What website, from whom, which publication/date, etc.?
I acknowledge that I have read and understand the MotherLode Harvest Customer Policies and have completed the Customer Agreement .
I am interested in becoming a producer member for MotherLode Harvest.


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