Information will remain confidential and will only be used for this program.
* indicates required field
Farm Business Name *
Farm Business Address *
City *
State *
Zip code *
Mailing Address (if different)
City
State
Zip code
Farm Owner *
Farm Contact Person *
Email Address *
Telephone *
Cell phone
Best time to call *
Email Telephone Cell phone
Yes No
If no, why?
Not aware Not qualified Other
If other, please explain:
Electric:
Gas:
If yes, when? Within the past
2 years 2-5 years 5-10 years 10+ years
Other (please describe):
Name of electric company
Monthly cost
Annual cost
Monthly kWh
Annual kWh
Used for
Name of gas company
Monthly therms
Annual therms
Name of oil company
Monthly gallons
Annual gallons
Name of diesel company
Name of propane company
Name of bio-fuel company **
Monthly amount
Annual amount
Indicate unit of measurement entered in previous two questions
Gallons Pounds Cubic feet
** If self, please indicate "self"
If you provide this information, it will assist us in determining your eligibility and potential scoring to apply for USDA/Rural Development REAP grant and loan program. (Read more about the USDA/RD REAP program.)
An agricultural producer is an individual or entity directly engaged in the production of agricultural products, including crops (including farming); Livestock (including ranching); forestry products; hydroponics; nursery stock; or aquaculture, whereby 50% or greater of their gross income is derived from the operations.
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