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Country Haven Farm & |
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Meat & Poultry CSA Sign
Up Form Household Name:______________________________ How many in your household?______ Address:___________________________________________________________________ City/State/Zip:______________________________________________________________ Primary Phone:________________________2nd Phone:_____________________________ Email:______________________________________________________________________ Share Options: _____Large Share (full grocery bag) - $780 for 6 mos. of great meat, deposit required $260. _____Medium Share (3/4 of a grocery bag) - $600 for 6 mos. of great meat, deposit $200. _____Small Share (1/2 of a grocery bag) - $480 for 6 mos. of great meat, deposit $160. _____Ground Meat Share (Beef, Lamb & Pork) - $480 for 6 mos. of ground, deposit $160. Payment Options: We accept check, credit card or cash. ____ Single Payment - Total Amount Enclosed = $______________. ____ 3 Payments - Deposit due w/Signup; 1/3 due at 2 months; 1/3 due at 4 months. For credit card payment complete this section: VISA Mastercard Name on card:_________________________________Card No._______________________________________ Billing address if different: _____________________________________________________________________ Expiration Date: _____\_______ 3-Digit Code on back of Card: _________ Delivery Locations: more to be added in your neighborhood. _____ Franklin, 8520 S Golden Lake Way _____ Milwaukee West, 2845 S 70th St _____ Pewaukee Park-n-Ride lot; I-94 Exit 291, Co Rd G & Golf Rd. _____ Shorewood, 4043 N Downer Ave _____ At the Farm, 211 Canal Road, Waterloo ____ I'd like to be considered for a host location. (Once you acquire 10 shareholders at your location, you receive a 25% discount off your CSA share!) You must have ability to store product until picked up by CSA shareholders. Delivery Dates: Second Thursday of each month. Return this completed form with your payment to: Country Haven Farm Questions: Call Anna or Chuck at 920-253-8515 or email. When we receive your form
and payment, we will confirm your membership with an email. Thank
you for becoming a shareholder!
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