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2010
Community Supported Agriculture Sign-Up Form
CSA 426
Jerry Lane NE. Check, VA. 24072
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| FILL OUT THIS FORM, PRINT IT, THEN SEND IT TO US VIA U.S. MAIL. |
| NAME |
2nd Member |
| ADDRESS |
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| PHONE |
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| EMAIL |
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| Occupation, skills, other ways you
can help: |
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| Payment
Options 1. Sliding Scale - you choose what price to pay within the range given. 2. Full payment on or before 4/1/10 or upon sign up. No service charge 3. Payment Plans - There are 2 options: 4 equal payments due 4/1, 6/1, 8/1,10/1 or 8 equal monthly payments. There is a $15.00 service charge on all payment plans. SHARES: Please sign me up for the following share(s) in your CSA garden for 2009. |
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| Cost |
Payment
Plans check one |
Amount Enclosed |
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| # Type of Share |
$ Sliding Scale |
Enter Price chosen |
Full
Pay |
4 payments |
8
payments |
|
| Full share with 16 hrs labor | $943.00-1243.00 |
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| Half share with 8 hrs labor | $560.00-760.00 | |||||
| Full share non working | $1130.00-1403.00 | |||||
| Half share non working | $640.00-840.00 | |||||
| Herb share | $27.00 |
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| I would like to contribute the following to the Low Income Share Fund: | ||||||
| I would like to reserve the above shares with a deposit min. $25.00, and pay the balance due by April 1 | ||||||
| I am interested in helping with events | ||||||
| I am interested in helping with the CSA newsletter | ||||||
| I would like to receive weekly CSA information
notes; By E-mail On paper, stapled to my bag you may check both |
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| Make check payable to: CSA Mail to: CSA 426 Jerry Lane NE, Check, VA 24072 | ||||||
| TOTAL AMOUNT being mailed, based on this application: | ||||||
| I would like to pick up my food at the following
location: Floyd Roanoke Blacksburg Christiansburg Seven Springs Farm Please check any of these that apply: I have read the accompanying proposal. I agree to pay my share of the cost of growing and distributing the harvest from the CSA garden at Seven Springs Farm. I agree to make my payments on time. Signature: |
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| Fruit Share
Information Click Here. |
Egg
Share
Information Click Here. |