Member Contract
Member Contract 2012
Name: ____________________________________________________________
Mailing Address_____________________________________________________
City___________________________________________Zip_________________
Phone home:_______________work_________________Cell________________
Email:______________________________________________________________
If you are splitting a share please include your share partners information as well:
Name: ____________________________________________________________ Mailing Address_____________________________________________________ City___________________________________________Zip_________________ Phone home:_______________work_________________Cell________________ Email:______________________________________________________________
Pick Up Location: ________Prescott (tuesdays) _______Farm (wednesdays)
How did you hear about us?
From our Brochure
At the Farmers Market
From our email newsletter
From our Website
From a friend (please tell us who)
Some other source (please specify)
COST and PAYMENT OPTIONS
The total cost is $550 for the season.
______ $50 due with contract to hold your spot
______ Payment in Full: $500 due March 1, 2012 (if deposit is not prepaid $550 is due March 1)
______ Two Payments: $250 due March 1, 2012; $250 due July 1, 2011 (If deposit is not prepaid $300 is due Mar 1, $250 is due July 1)
______Additional amount towards the Farm Share Fund $______________ (to help give CSA shares to families in need)
Please make checks payable to Whipstone Farm
As a member of the Whipstone Farm CSA, I understand that my share payment does not guarantee me an exact amount of produce. I am making a commitment to support Whipstone Farm and to share in the rewards and the risks of the growing season. I also understand that my payments are non-refundable. It is my responsibility to pick up my share at the designated time and place. I understand that if I am out of town or otherwise unable to receive my share at any time during the season, I am responsible for contacting someone to gather my produce or it will be donated to a local food bank.
_________________________________ _______________
Signature Date
Mail this form to:
Whipstone Farm
21640 N. Juniper Ridge Rd.
Paulden, AZ 86334