The Organic Farm

Veggie Co-op

Sign Up

Veggie Coop Returning Member Application
2008 Season

*Required Items
Contact Information:
Name*:
E-Mail*:
Address:
Work Phone:
Home Phone:
Cell Phone:


Membership Types and Payment Rates:
Small Bag (Mondays):
Large Bag (Wednesdays):


Payment Options:
Checks are the preferred form of payment.

If this is not feasible, please Contact Us to make a plan.


Dated Payable June 15th
Dated June 15th and August 15th
Dated June 15, July 15th, August 15th, and Sept 15th

Please make checks payable to: Organic Farm

Arrangements for pick-up:


Additional Information:
We would like to know how many people are benefitting from the Veggie Coop.

For our information and statistics, please describe the names of other families who may be sharing a bag and their vital statistics, for both grown-ups and children.

Number of Families:
Number of Adults:
Ages of Adults:
Number of Children:
Ages of Children:
Sharing with:
E-Mail:
Phone:


Holidays:
If you are planning holidays, please remember to let us know in writing.