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Country Haven Farm &
Marr's Valley View 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: _____ Franklin, 8520 S Golden Lake Way _____ Milwaukee West, 2845 S 70th St _____ River Hills, 7953 N Range Road _____ Shorewood Area, 2919 N Prospect _____ Wild Workouts & Wellness, 2469 S Kinnickinnic Avenue _____ White Fish Bay, 1578 E Cumberland Boulevard _____ At the Farm, 211 Canal Road, Waterloo 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. |