(FOR ALBERTA PRODUCERS ONLY)
3. Farming Practice Details – please provide information for all equipment used in your farming operation:
AUTHORIZATION FOR RELEASE OF INFORMATION: The Undersigned hereby authorizes the above named Crop Insurance Corporation and its successors or assigns to release any information within said corporation’s possession, power or control pertaining to the contract number(s) between the Undersigned and said corporation including, but not limited to, any and all information which said corporation may have with respect to the agriculture operations of the Undersigned to Terra Verde and its lawful representatives, agents, employees, officers and contracting parties. This authorization is irrevocable for all contract years included in the agreement between the Undersigned and Terra Verde specified above unless otherwise terminated in writing by Terra Verde and the Undersigned.
Producer (or authorized officer) signature(s)
C/S Witness (if Producer is an individual)
By accepting below and submitting this application, the producer named herein agrees that in submitting this form electronically to be bound by all of the terms and conditions, representations and warranties contained in Terms and Conditions (pointing them to that on that same page of the website). The producer further represents and agrees that it is the Producer named in the Application and Contract and has full right and authority to make this application for inclusion in the Terra Verde contract and unconditionally agrees to be bound by all terms in the Application and Contract.
