Thank you for your interest in Big R's Ag Plus program. Please print this form, complete, and send it to your local Big R.
For a list of Big R locations near you, please click here.
(click here to download and print this in PDF Format)

Name: _______________________________________________

Address: _____________________________________________

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City:______________________ State: _______ Zip Code: _______

Please circle the Ag Products you produce:

Grain Farming • Cattle • Horses • Sheep • Swine

Rabbits • Poultry • Goats • Emu and Ostrich

____Other (please explain)______________________________

Are there any items that you use in your Agricultural business that you would like to see us carry?

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Signature:______________________________________________

Date:_________________________________________________