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2.	For identification purposes only, please specify your month of birth.

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3.	Title (select only one)

General Administrative	Marketing & Sales
Mill/Plant Operations	Other (please specify)
Vets, QC, Nutritionists

4.	Primary Occupation: (Please check primary business operation at this location and give volume information)

Feed Manufacturer

Product(s) Manufactured:

Complete Feeds

Premixes/Base Mixes/Supplements/Concentrates

Grinder/Mixer

Consulting:

Nutritionist

Veterinarian

Other Consultant (please specify)

Other (please specify)

5.	FDA Registered Mill?

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6.	Indicate your average weekly tonnage: (select only one)

500 or more tons	100-199 tons
200-499 tons	Less than 100 tons

7.	Types of feed manufactured or sold at this location: (select all that apply)

Dairy/Beef	Fish
Poultry	Pet
Pig	Other

8.	Indicate capacity of grain storage at this location: (select only one)

No Storage	2,500,001 to 5 million bu
1 to 500,000 bu	Over 5 million bu
500,001 to 2.5 million bu

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