CSA Order Form
Available shares
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( X )
Vegetables Share
Regular share - approximately 15 lbs
$
10.00
Amount
1
2
3
4
5
6
7
8
9
10
Fruits Share
Regular share - approximately 15 lbs
$
10.00
Amount
1
2
3
4
5
6
7
8
9
10
Eggs Share
Per dozen
$
6.00
Amount
1
2
3
4
5
6
7
8
9
10
Chicken Share
Regular share - approximately 18 lbs
$
20.00
Amount
1
2
3
4
5
6
7
8
9
10
Pork Share
Small share - approximately 15 lbs
$
30.00
Amount
1
2
3
4
5
6
7
8
9
10
Turkey Share
Small share - approximately 12 lbs
$
30.00
Amount
1
2
3
4
5
6
7
8
9
10
Name
First Name
Last Name
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mode of Payment
Check
Credit Card
Money Order
Wire Transfer
Bank Transfer
Other
Payment Plan
Full
Installment: Monthly
Installment: Quarterly
Installment: Every 6 months
Drop Off Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about us?
Facebook
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Google Search
Referred by a friend
Newspaper/Magazine
Other
Any comments or instructions?
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