|Print & Mail||
Country Haven Farm &
Marr's Valley View Farm
Meat & Poultry CSA Sign
Household Name:______________________________ How many in your household?______
Primary Phone:________________________2nd Phone:_____________________________
_____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: _________
_____ 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
Anna or Chuck at 920-253-8515 or