Wild Carrot Farm 2017 Summer Veggie CSA Sign Up Form
Yes! I'd like to sign up for the 2017 CSA season. The summer share will run 21 weeks, from June 6th through October 27th.
Email address
Secondary email to receive newsletters
Your answer
Last Name
Your answer
First Name
Your answer
Address
Your answer
Phone Number
Your answer
Summer Full Veggie Share:8-10 items per week (Sliding Scale): $590-$645
Summer Half Veggie Share: 4-5 items per week (Sliding Scale): $350-$385
Price I'd like to pay: (based on your means)
Your answer
Scholarship Request
Scholarship Donation - I'd like to make a donation to the Wild Carrot Farm Scholarship Fund and help make scholarships available to my neighbors! I would like to donate this amount:
Your answer
Total Price:
Your answer
Thank You!
We look forward to sharing our harvest with you this year and will be in touch soon!
Please mail or drop off your $100 non-refundable deposit to the farm at

511 Upper Dummerson Rd, Brattleboro, VT 05301.

The remaining balance will be due at the first pickup in June unless you make arrangements for a payment plan or want to pay with EBT.

A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms