Name*Qualifications*Contact Details: Mob*Email addressLand Line:Age*Referred By:*Residential Address* LAND ASSESMENT:Land Ownership: *Please selectOWNFAMILY OWNED LEASESize of land in acres*Address of the land:*CURRENT Agricultural Activity:*Soil Type: Closest Poultry Farm: *Please selectYesNoDistance?Fencing to your farm:*Please selectYesNoType of fencing?Shade Trees: *Please selectYesNoDetails? WATER ASSESMENT:SOURCE*Please selectWELLBOREQuantity in inch*TYPE*Please selectHARDSOFT LIFESTOCK:COWS / GOATS:*Poultry experience*Please selectYesNoDetails GENERAL DETAILS: Labor Living in farm*Please selectYesNoDetailsLand in Village *Please selectPanchayatUrbanNearest Town / City Details:*Are you practicing Organic Farming*Please selectYesNoDetailsElectricity*Please selectDomesticCommercial Nearest Bus / Railway station:*Farmer Group Member:*Please selectYesNoDetails WHAT IS YOUR EXPECTATIONS?Other details: SendThis field should be left blank
