This form is a printable intake. Buyer fills in contact, order details, and line-item quantities; both parties sign; farm counter-signs on PO acceptance. Pair with the Wholesale Offer Sheet (prices + MOQ cadence) and the Wholesale Buyer FAQ (pack weights, lead time, certifications).
Buyer contact
Order details
☐ Tue ☐ Fri ☐ Other: ____________________
☐ One-time ☐ Weekly ☐ Bi-weekly ☐ Monthly
Line items
| Variety | Pack size (clam 1 lb / flat 5 lb / flat 10 lb) | Qty (lb) | Unit price / lb | Line total ($) |
|---|---|---|---|---|
| Sunflower micro | $11.00 [DRAFT] | |||
| Pea shoots | $13.00 [DRAFT] | |||
| Radish (Daikon) micro | $15.00 [DRAFT] | |||
| Broccoli micro | $15.50 [DRAFT] | |||
| Wheatgrass | $7.00 [DRAFT] | |||
| Mixed brassicas | $14.00 [DRAFT] | |||
| *Draft tier-1 pricing (midpoint of published Tier 1 range). Final unit price confirmed by IronRoost Farms on PO acceptance. See /wholesale-offer-sheet.html for tier-2 (10–50 lb / wk) and tier-3 (50+ lb / wk) rates. | ||||
Subtotal (USD)
Volume tier discount
(none)
Sales tax
exempt — farm-direct wholesale, VA produce
Total (USD)
Acknowledgement & signature
By signing below the buyer agrees to IronRoost Farms’ published MOQ per variety per drop (5 lb minimum), 48-hour order confirmation cut-off, Tue/Fri delivery cadence across Richmond / Charlottesville / Southside VA, first commercial harvest cycle window August–September 2026, and Net-30 default terms · ex-farm pricing, all as published on the companion Wholesale Offer Sheet. Phase 2 secondary lines (basil, cilantro, amaranth, arugula, kale) are available on request and fold into the standing weekly slot ahead of the baseline schedule.
Buyer signature & date
Print name
IronRoost Farms rep signature & date
Print name
Food-safety posture: VDACS regulated-facility filing in process · GAP pre-audit underway · HACCP concurrent with commissioning · lot ID + harvest-date on every case · CoA available on request · cold-chain integrity from harvest table through dispatch · full third-party GAP audit targeted Q1 2027.