Full Cellar Farm 2017 Membership Form
City, State, ZIP
Choose your Membership
If you'd like more than one of any given share, please indicate that in the Notes field below.
Sign me up for the weekly vegetable share! ($500)
23 weeks of vegetables, chosen by you! To sign up, please enter the number of shares you'd like to purchase.
Sign me up for the Fill Your Cellar share! ($300)
The "Fill Your Cellar" share includes bulk quantites of over a half-dozen preserving and storage crops. See
for details. To sign up, please enter the number of shares you'd like to purchase.
I'd like to contribute to the Full Cellar Farm scholarship fund!
Scholarship donations will be used to help members in need of financial assistance. If you'd like to contribute, please enter the amount below.
Total amount due
(Total amount of shares plus optional donation)
(Payment questions, names and email addresses of anyone you're sharing with, or anything else you'd like to note!)
Method of Payment
Please choose one
Check: Please make your check out to Full Cellar Farm and mail it to the address below.
Credit Card: After submitting this form, go to
to complete your payment. Please note: Credit card prices are slightly higher to cover the processing charges.
SNAP: We will contact you to make payment arrangements.
SNAP with Double Up Food Bucks: Double Up Food Bucks is a SNAP matching program that is only available to people who receive SNAP food benefits (not cash) and who were not a member of a CSA in 2016. Funds are limited and available on a first-come, first-serve basis.
Choose Your Pickup Spot
(Pickup days & times are listed in parentheses.)
SE Portland, 2445 SE Yamhill (Wednesdays, 4:30 to 7:30 pm)
SE Portland, 243 SE 78th Ave (Wednesdays, 4:30 to 7:30 pm)
NE Portland, Blue Ox Athletics, 418 NE 8th Ave (Wednesdays, 4:30 to 7:30 pm)
NE Portland, 3914 NE 16th Ave (Wednesdays, 4:30 to 7:30 pm)
Gresham, Crossfit PDX, 2206-1 NW Birdsdale (Tuesdays, 5 to 7 pm)
Sandy, 39307 Cascadia Village Dr (Tuesday evenings)
How did you hear about the farm?
Please be as specific as possible.
Thank you for signing up for the Full Cellar Farm CSA! I look forward to growing for you in 2017!
Payments can be mailed to:
Full Cellar Farm
c/o Emily Cooper
250 SE Vista Ave #31
Gresham, OR 97080
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service