NMFMA Nutrition Incentive Program Application 2021 (Single POS Retailers)
Use this form to sign up for the Double Up Food Bucks and/or Fresh RX programs for the 2021 season.

Double Up Food Bucks is the nutrition incentive program for SNAP customers to receive free fresh fruits and veggies with their EBT Card. Interested markets are encouraged to apply for participation in the program, even if this application cannot be filled out in full. More information will be provided after you apply. Questions may be sent to Sarah Thompson at sthompson@farmersmarketsnm.org.

Fresh Rx is a new nutrition incentive program from the NMFMA and markets associated with this program have already been selected and have begun the process of implementing this program in their community. If you are not part of this program, you cannot sign up for it. Questions may be sent to kirsten@farmersmarketsnm.org.
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Name of person filling out this application
Primary Contact for Double Up and/or Fresh RX
Primary Contact Email Address
Primary Contact Phone Number (no dashes or spaces)
Farm Stand/Mobile Market/CSA Name
Who should mail be sent to? (Name of person or business)
Mailing Address (Street and Unit)
Mailing City
Mailing State
Clear selection
Mailing Zip
Should checks be sent to the mailing address listed above? If no, provide the correct mailing address in "other"
Clear selection
Outlet Location Address 1 (Ex. 405 East 2nd St)
Outlet Location Address 2 (Ex. Suite A)
Outlet Location City
Outlet Location Zip
If there are additional locations, please list here:
Do you know an exact date that your outlet will open in 2021? If so, enter it below. (Year-round outlets should enter 1/1/21)
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YYYY
If you do not know an exact date your outlet will open in 2021, let us know an approximate date and/or when you will know by.
What days of the week and times will your outlet be open? (Ex. Mondays from 12pm until 5pm or Saturdays from 7am through 12pm)
Do you know an exact date that your outlet will close in 2021? If so, enter it below. (Year-round markets should enter 12/31/21)
MM
/
DD
/
YYYY
If you do not know an exact date your outlet will close in 2021, let us know an approximate date and/or when you will know by.
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