2023 Sliding Scale CSA Registration Questionnaire
Hello! Please answer the questions below. The questions are meant as a way for us to collect your contact info so we can get ahold of you when we we need to, and questions to help us gain a better understanding of your CSA sliding scale request. Note, this info is for internal purposes only and will not be shared.
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Today's Date *
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First name *
Last name *
Email address *
Confirm email *
Phone number *
Age
How many people in the household
Median household income
How much are you comfortable paying for a CSA share?
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Race
Do you plan to use SNAP EBT and Double of Food Buck Benefits to pay for your CSA share on a weekly basis?
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If you are NOT using SNAP EBT or Double Up Food Bucks, are you able to pay for your season long share...
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Which pick up location would you like to pick up your share? Please note: If you are planning on using SNAP and Double Up Food Bucks, you will have to pick up at the South Salt Lake Hub.
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I understand that this is a season long commitment and I will not back out at any time. *
I understand that no refunds will be available at any time. *
Comments or Questions?
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