MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C87F76.936EA6B0" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Microsoft Internet Explorer. ------=_NextPart_01C87F76.936EA6B0 Content-Location: file:///C:/2674CAAD/NewProducerForm.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Producer Form

        &= nbsp;           &nbs= p;            &= nbsp;            Indi= ana Packers Corporation

        &= nbsp;           &nbs= p;            &= nbsp;         Producer Form

 

 

 

Farm/Producer Name:___________________________________= ______________ Producer #______________

 

Address:_______________________________________________ Premise ID#__________________

 

City:________________________________

 

State:_______________________________  Zip:______________

 

County:_____________________________

 

Phone #____________________   Fax #____________________

 

Mobile #___________________

 

 

 

Please circle= the correct choice:

 

Insurance: Y<= /b> or N

 

SIP: Y or= N

 

Food Safety: = Y or N        =      Date Food Safety Signed: _______________

 

Print Detail kill sheets: Y or N        Fax kill sheets: Y or N

 

Feed Info<= /u>

 

Feed Company: _________________________________

 

Pre-Mix: Y or N               =             &nb= sp;      Concentrate: Y or N           &= nbsp;   Complete: Y or N

Pet Food By-Products: Y or N        =    Beef Meat Bone Meal: Y = or N

Pork Meat Bone Meal: Y or N

 

Please complete all of the information and fax to:

(765)564-3684=   Attn: Suzanne

OR

Return by mail to:

Indiana Packe= rs Corporation

PO Box 318

Delphi, IN  46923=

Attn: Suzanne= Hughes

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