Certified Producer Renewal Form To view this form, please enable JavaScript in your browser. If you do not show any animals harvested or milked, please send a signed letter with the explanation. You must keep all fees current. Thank you - American Grassfed Staff Payment Type Credit Card Pay By Check Main Contact Producer Company Name Producer First Name Producer Last Name Address 1 Address 2 City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Phone Email AGA Member Number Number Beef Harvested @ 1.00 Beef Total Number of Bison Harvested @ 1.00 Bison Total Number of Sheep Harvested @ 0.25 Sheep Total Number of Goat Harvested @ 0.25 Goat Total Number of Dairy Milked @ 1.00* Dairy Total * If you are part of the Horizon and/or Kalona milk program, you will be sent an invoice to pay for your fluid poundage fees. Number of Pork Harvested @ 0.50 Pork Total Subtotal Online Convenience Fee Certified Producer Membership Total Credit Card Information Credit Card Type MastercardVisaDiscoverAmex Credit Card Number Name on Card Security Code Valid Through 01 02 03 04 05 06 07 08 09 10 11 12 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 Address City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Phone Credit Card Email Address Please click submit only one time. The transaction may take several seconds.