• 
• Name of Farm*
• City
• State*
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
• Contact Name*
  First Name Last Name
• Title*
• Phone Number*
   - Area Code Phone Number
• Email
  example@example.com
• How many pounds do you have available now?*
• Are you still harvesting?
  Yes No
  
• How many pounds will you be harvesting?*
• When will it be dry and available to ship?*
• Are you interested in having a portion of your biomass processed in to Crude Oil?
  Yes No
  
• Are you interested in high-quality 75% to 85%+ CBD Crude?
  Yes No
  
• Do you require your Crude to be Winterized and Decarbed?
  Yes No
  
• What price are you expecting to sell your material for?*
• How many pounds would you want to have processed?*
• Notes
• Submit
• Should be Empty: