2062 Ebenezer Ch. Rd.

, Archdale, NC 27263

CSA Application
2013 Summer/Fall Season

August 18th October 20th Date______________ Name_____________________Spouse(if applicable)__________________ Address___________________________________________________________ Phone(Home) _____________________ Cell __________________________ Share Choice: _____ 1. Full Share You will receive a basket of seasonal produce for 10 consecutive weeks, enough to feed 2-4 people _____ 2. Half Share You will receive a basket of seasonal produce for 5 weeks ( pickup is every other week), enough to feed 2-4 people Payment Options: (Checks payable to Farlow Farm) _____ 1. Pay in full with check _____ Full share - $250 _____ Half share - $125 _____2. Pay in full with paypal invoice or credit card($10 additional fee) _____ Full share - $260 _____ Half share - $135

Pickup Preference: _____ 1. Farlow Farm on Mondays 4:30-6:30p.m. _____ 2. New Garden Nursery & Landscaping (Lawndale ) on Thursdays 10-12p.m. _____ 3. Greensboro Farmers Curb Market on Saturdays 7-12p.m.

Add-ons: _____1. Full egg share 1 dozen free range, multi-color eggs for 10 weeks; Cost - $35 _____ 2. Half egg share 1 dozen free range, multi-color eggs for 5 weeks (pickup every other week). Cost - $17.50

TOTAL ________________