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Business Name*

Primary Contact*

First Last

Business Mailing Address*

Street Address Address Line 2 City State ZIP Code

Physical Address (if different than mailing address)

Street Address Address Line 2 City State ZIP Code

County Business is located in*

Business Phone Number*

Will be publicly displayed on website.

Business Email*

This will be publicly displayed on the website.

Business Website*

Describe your business in complete sentences, please:*

First 130 characters will be displayed in listing. Full description will be on your profile page.

Owner's Name*

First Last

This will NOT be publicly displayed on the website.

Owner's Email*

This will NOT be publicly displayed on the website.

Owner's Phone Number*

This will NOT be publicly displayed on the website.

Owner's Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

This will NOT be publicly displayed on the website.

Product(s) description in complete sentences, please:*

Please check the appropriate governing agency for your business below:*

South Carolina Department of Agriculture
South Carolina Meat and Poultry Inspection Department
South Carolina Department of Health and Environmental Control

Please provide your Registration Verification Certificate Number (SCDA) or other certification number (SCDHEC):

Please check the following boxes to indicate which outlets you sell your products to or through:*

Wholesale
Retail
Food Service
Internet

Are you a member of the Certified South Carolina Program? (Check Below)*

Yes
No
I have applied for membership

Does your business have an online store?*

Yes
No

Online store website address:*

Where can your product(s) be purchased*

Please check the following boxes to indicate where your products can be purchased; you may also list the various locations your product(s) are sold if you wish.

Website(s)
Grocery Stores
Specialty Shops
Farmers Markets
Other

Product(s) sold on Website(s)

Product(s) sold in Grocery Stores

Product(s) sold in Specialty Shops

Product(s) sold in Farmers Markets

Product(s) sold other places

Does your business utilize social media?

Please check the following boxes to indicate which social media sites, if any, that your company uses. If your business’s account name is different from the business name listed on this application, please indicate the name of the account used.

Facebook
Twitter
Instagram
Other

Facebook

Twitter

Instagram

Other

Membership Level*

Please select the level of membership you wish to obtain for the 2023 year below. Please note that if your business does not have the appropriate registration or licensing necessary to sell your product, the business will be listed as an associate member until this registration/licensing is acquired. The business will also be listed as an associate member if the business is not a member of the Certified South Carolina Program.

Active Member (January 2023 – December 2023)
An Active Member is a business or individual actively involved in the manufacture or production of a food product.
Associate Member (January 2023 – December 2023)
An Associate Member is a business or individual that is associated with or has interest in the specialty food industry and supports the objectives of the Association.

Payment Method:*

Check
Credit/Debit Card

Please make checks payable to: SCSFA

Mail to:
South Carolina Specialty Food Association
Attn: Suzy Ellison
P.O. Box 11280
Columbia, SC 29211

Total

$0.00

Credit Card

Card Details

Cardholder Name

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