Lowlands Farm

2019 Produce CSA Order Form

Name______________________________________________________________________________________

Address____________________________________________________________________________________

City________________________________________________________ Zipcode________________________

Phone____________________________ Email(s)__________________________________________________

Facebook Profile Name or URL (optional) _______________________________________________________

        *we only use this to add you to our private facebook community group!

Check your pick-up location

_____ On the farm (Snohomish) - Tuesdays

_____ In Mill Creek - Tuesdays

_____ In Ballard - Tuesdays

MEMBERSHIP FEES for 2019

Weekly:         ______ Pay in Full ($700)

______ Plan A-Two payments: First payment of $350, second payment of $350 due on

             July 15th

______ Plan B-Three payments: First installment of $185, second payment of $258 due

             on July 15th, third payment of $258 due on July 15th

Bi-weekly:         _____ Pay in Full: $370

_____ Two payments: First Installment of  $185, second payment of $185 due on July

15th

Cut Flower Add-on:          

Weekly (10 bouquets):                       _____ Pay in Full: $180                

Bi-weekly (5 bouquets):         _____ Pay in Full: $108

Dahlia Share (4 bouquets):        _____ Pay in Full: $80

Please include recipient's name and email if the flower share is a gift!

____________________________________________________________________________________

Total amount enclosed _____________________________

(Credit/Debit, online payments will be available soon!)

Please make checks out to “Lowlands Farm”

⏯  I have read,  understood, and agree to the details of the CSA Membership

Signature______________________________________________ Date________________

Please Print, Sign and Return this page with your check to:

Lowlands Farm, 10890 Elliott Road, Snohomish, WA 98296