<
form action = "https://webto.salesforce.com/servlet/servlet.WebToCase?encoding=UTF-8"
method = "POST" >
<
input type = "hidden"
name = "orgid"
value = "00D6g000006wOuu" >
<
input type = "hidden"
name = "retURL"
value = "https://saafon.org/about-us/confirm/" >
<
h3 > Farmer Support Request < /h3>
To request assistance, please use this web – to –
case form to submit a Farmer Support request.
Please fill out the form below and one of our state coordinators will be in touch soon.
Fields marked with an * are required
Please provide your contact information.
< label for = "name" > First and Last Name*: < input id = "name" maxlength = "80" name = "name" size = "20" type = "text" required = "true" >
< label for = "email" > Email *: < /label>
< label for = "phone" > Phone *: < /label>
Farm or Company Name,
if applicable: < input id = "00N6g00000RdAv7"
maxlength = "100"
name = "00N6g00000RdAv7"
size = "20"
type = "text" >
Please provide a short title about your issue / need.
< label for = "subject" > Subject *: < /label>
Provide more details about your issue / need in the descriptions field below.
< label for = "description" > Description *: < /label> < textarea name = "description" required = "true" > < /textarea>
Click the Submit Query button to submit your request
< input type = "submit" name = "submit" >
< /form>