To Retailers, Distributors, & Producers of Poultry & Egg Products Claimed to Derive from "Free Range," "Free Roaming," "Free Running," or "Free Walking" Birds:

I am a responsible consumer concerned about how commercial so-called "free range" birds are actually being raised. would you please fill out this form and return it to me as soon as possible in the attached self-addressed stamped envelope? Thank you for your help.

Name of Company: 
Address:  
Proprietor:  
Type of Bird: Egg Type Hen Broiler chicken Turkey
  1. How many birds are housed together at a time in what size building?
    Open-Sided Controlled-Environment
  2. How many square feet of floor space does each bird have at maturity?  
  3. Are the birds debeaked or trimmed?  If so, please describe:

  4. Do all the birds have easy access to the outdoors during the day?   
    Please clarify:
  5. If the birds can go outside, what does the outdoor range provide?
    Exercise Gravel Yard Soil Vegetation
    Other (please specify) 
  6. Do the birds have roosts?    If so, please describe:
  7. Do the birds have perches?    If so, please describe, including the amount of perch space per individual bird.   
  8. Do the birds have ample dustbathing areas?   
    If so, what are the dustbath materials made of?    Wood Shavings   Sand   Peatmoss    Other(please specify) 
  9. What are the feed ingredients, including medications?
  10. What is the form of the feed?   Mash Pellets Crumbles Scratch
  11. Are the birds ever force molted?    If so, please explain the reasons & procedure:

  12. At what age are the birds sent to slaughter?    
    How much do they weigh at age of slaughter?   
  13. How many miles do they travel to the slaughter plant?  

Signed,

Signature
Position
Date

Thank you very much.