Your Information

First Name (required)

Last Name (required)

Address (required)

City State Zip

Email (required)

Telephone (required)

How many people eat regularly in your household (i.e. at most meals?)

Please estimate how many vegetable servings you personally eat daily: Weekly?

How many times per day do you prepare vegetable dishes for main meals?

And how many per meal?

Breakfast Lunch Snacks Dinner

How do you currently get fresh produce? (grocery, food pantry, delivery, garden; if other please note)

If possible, please estimate your food budget for the month:
a. Do you spend more than $20/week on produce?  Yes No

b. Will you be sharing this produce box with another person / household?

If yes, I am splitting the cost of the CSA with (first and last name)

c. Would it be easier for you to enroll if the farm accepted LINK as payment?  Yes No

Payment Information

The total cost of the CSA is $400 ($20/week x 20 weeks).

I plan to pay in installment(s).

I plan to pay in