Shareholder Agreement - Blackberry Meadows Farm (Page 3 of 3) in pdf

Sign me up for:

Circle One Share Size and Payment Plan

Share Size:

Basic (pick up weekly)

BiWeekly Basic (pick up two shares every other week)

Payment Plan: Good Samaritan ($550),

Standard ($650),

Supporter ($850)

Circle One Pick up Location:

On Farm (Wednesdays 11 - 7), Phipps Mkt. (Wednesdays 2:30 - 6:30), On Farm (Sundays 11 - 3)

Market Membership Card ($50 each for $60 value):

How many cards are you purchasing? _______________

Sign me up for the Homestead Hog Share ($850) ___________________

How long have you been a member/ How did you find us? ___________________________

What is your favorite and least favorite Vegetable?_________________________________

Did anyone recommend our CSA to you? Who? __________________________________

Have you recommended our CSA to a new member? Who? __________________________

Primary Subscriber: (The main contact responsible for the CSA Share)

Name____________________________________________________________

Home Phone ___________________Alternate Phone __________________________

Street______________________________________________________________

City/Town _______________________________State ______________Zip ________

E-mail _____________________________________________________________

Please list all those sharing your CSA share. Note that even if you are sharing your produce with others, you

are responsible for meeting all the financial obligations that your share ownership carries with it.

Name ________________________________________________________________

Home Phone ___________________Alternate Phone __________________________

Street ________________________________________________________________

City/Town _______________________________State ______________Zip ________

E-mail ________________________________________________________________

Name ________________________________________________________________

Home Phone ___________________Alternate Phone __________________________

Street ________________________________________________________________

City/Town _______________________________State ______________Zip ________

E-mail ________________________________________________________________

Shareholder Agreement - Blackberry Meadows Farm Page 3