OMB No. 0581-0178

FTC-102-75 (Exp. 3/31/2024) Destroy previous editions.

FLORIDA TOMATO COMMITTEE

800 Trafalgar Court, Suite 300 • Maitland, FL 32751

Phone (407) 660-1949 • Fax (407) 660-1656

www.floridatomatoes.org

APPLICATION FOR REGISTRATION AS TOMATO HANDLER

I hereby apply for registration as a Tomato Handler for the 20___-20___ season. Each handler who handles 

tomatoes grown in the production area must be certified as a registered handler by the Committee in order to ship 

such tomatoes outside of the regulated area. A handler who is certified as a registered handler is a handler who has 

adequate facilities to meet the requirements of preparing tomatoes for market, obtains inspection on tomatoes 

handled, agrees to handle tomatoes in compliance with the marketing order’s grade, size and container requirements, 

pays applicable assessments on a timely basis, submits reports required by the Committee, and agrees to comply 

with other regulatory requirements on the handling of tomatoes grown in the production area. The Committee or its 

authorized agent shall inspect a handler’s facilities to determine if the facilities are adequate for preparing tomatoes 

for market. In order to be adequate for such purposes, the facilities must be permanent, non-portable buildings 

located in the production area with equipment that is non-portable for proper washing, grading, sizing and packing 

of tomatoes grown in the production area.

1. Company/individual address of all location(s) of grading and packing facilities in the production area:

______________________________________________________________________________________

______________________________________________________________________________________

2. Type of business (Individual, Firm, Partnership, Corporation, Co-operative, Association or other business 

unit): _________________________________________________________________________________

3. If other than individual, show below names and addresses of the officers, partners, or other individuals 

having a financial interest in the business with the applicant.

Name Title Address, City, State, Zip code

4. How many years have you been in the tomato business in Florida? ___________

Business Name of Applicant: ______________________________________________________________

Street Address: _________________________________________________________________________

City, State, Zip Code: ____________________________________________________________________

Mailing Address: _______________________________________________________________________

City, State, Zip Code: ____________________________________________________________________

Telephone Number: ___________________________ Fax Number: ________________________

Email address: __________________________________________________________________________

By: __________________________________________________ ____________________________________

Authorized Signature Title

 __________________________________________________

Print name

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a 

collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0581-

0178. The time required to complete this information collection is estimated to average 5 minutes per response, including the time for reviewing 

instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of 

information.

For Office Use Only

Date Received _______

RH Code _______

RH # _______
OMB No. 0581-0178

FTC-102-75 (Exp. 3/31/2024) Destroy previous editions.

CRITICAL INFORMATION REQUEST 

Please provide the information below for each grower who you expect will be shipping through your packing facility 

for the 20___- 20___ season. This information is needed to ensure that your growers are kept up-to-date on Florida 

Tomato Committee (Committee) activities and on subjects affecting the Florida tomato industry as a whole, such as: 

Medfly alerts; government regulations; labor situations; market conditions; etc. Return this form with your 

application for registration as a tomato handler. 

GROWER NAME _____________________________________________________________________________

CONTACT NAME ____________________________________________________________________________

ADDRESS ___________________________________________________________________________________

CITY, STATE, ZIP CODE ______________________________________________________________________

TEL. NO. ___________________________________ EMAIL: __________________________________________

GROWER NAME _____________________________________________________________________________

CONTACT NAME ____________________________________________________________________________

ADDRESS ___________________________________________________________________________________

CITY, STATE, ZIP CODE ______________________________________________________________________

TEL. NO. ___________________________________ EMAIL: __________________________________________

GROWER NAME _____________________________________________________________________________

CONTACT NAME ____________________________________________________________________________

ADDRESS ___________________________________________________________________________________

CITY, STATE, ZIP CODE ______________________________________________________________________

TEL. NO. ___________________________________ EMAIL: __________________________________________

GROWER NAME _____________________________________________________________________________

CONTACT NAME ____________________________________________________________________________

ADDRESS ___________________________________________________________________________________

CITY, STATE, ZIP CODE ______________________________________________________________________

TEL. NO. ___________________________________ EMAIL: __________________________________________

GROWER NAME _____________________________________________________________________________

CONTACT NAME ____________________________________________________________________________

ADDRESS ___________________________________________________________________________________

CITY, STATE, ZIP CODE ______________________________________________________________________

TEL. NO. ___________________________________ EMAIL: __________________________________________

(Make additional copies to list additional growers if necessary.)

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its 

Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on 

race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, 

family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in 

any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by 

program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American 

Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA 

through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. 

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at 

http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of 

the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to 

USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW 

Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. USDA is an equal opportunity provider, 

employer, and lender.