HLCP Corn Supplier Agreement Form

HLCP Corn Supplier Agreement Form

Please fill out the below information. This will include information about the Supplier as well as information about the Farm.

Thank You,

Harvestone Commodities

Supplier Name*

Provide your First and Last Name

Farm Name*

Input in the Farm Name associated with this Agreement.

Farm Street Address*

(Ex. 2841 3rd St. SW)

Farm City*

(Ex. Underwood)

Farm State*

Pick State from the Drop-down list.

Select

Farm Zip*

Supplier Phone Number*

Phone

Supplier Email Address*

Farm GPS Coordinates - North*

Provide the GPS Latitude (N) Coordinates of your Farm. (Ex. 47.37074)

If you don't know your Farm GPS Coordinates you can use the site below to help gather this data. (The link to this site is also be found on our Website.)

https://www.latlong.net/convert-address-to-lat-long.html

Farm GPS Coordinates - West*

Provide the GPS Longitude (W) Coordinates of your Farm. (Ex. -101.222169)

Supplier Agrees to Terms of Contract (Yes/No)*

By selecting "Yes" the Supplier agrees to the Declaration terms stated below.

Declaration:

The seller attests that:

• The crop-based feedstock sold to the buyer was harvested on land that meets the requirements set in the Clean Fuel Regulations and is CFR eligible.

• The feedstock meets the Excluded Lands criteria through the US EPA RFS2 Aggregate Compliance and is CFR eligible.

• The feedstock meets the following requirements set in the Clean Fuel Regulations through Legislative Recognition:

☒ Wildlife Habitat Criteria (Section 48 of the Clean Fuels Regulations)

☒ Damaging Agent’s Criteria (Section 49 of the Clean Fuel Regulations)

Select

Supplier Signature*

Type your First and Last Name. (This will represent your Signature)

By typing in your First and Last you acknowledge that the inputted information is true and accurate to the best of your knowledge and that you as the Supplier Agree to the Terms of the Agreement.

Send me a copy of my responses

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