SNAP Share Enrollment Form
Thanks for joining Greensgrow's SNAP Share program! Please fill out the following information so we can process your membership and begin delivering fresh local produce to you and your family!
Shares are delivered every other week, and payment is due in full for each month before the due dates listed below.

WE WILL NOT BE ABLE TO DELIVER YOUR SHARE IF PAYMENT IS NOT MADE BY THE DUE DATE!!

If you provide your card information below, we can process payments for you, or you can call or email your payment information to 215-427-2780, ext 3, or snapshare@greensgrow.org.

December deliveries - Payment due by 11/20
January deliveries - Payment due by 12/20
February deliveries - Payment due by 1/17
March deliveries - Payment due by 2/14
April deliveries - Payment due by 3/14

Name *
Your answer
Email address
Your answer
Phone number *
Your answer
Zip code
Your answer
How many children are in your household?
Your answer
Is your household income below the SNAP-eligibility threshold?
Monthly income limit: 1 person - $1,619, 2 people - $2,195, 3 people - $2,771, 4 people - $3,347, 5 people - $3,923, 6 people - $4,499
What share type would you like to sign up for? *
What protein choice would you like included? *
Where would you like your share delivered? *
If you don't wish to pickup your share at a Greensgrow location, please consult this map - https://tinyurl.com/yagl6d9g - and write the alternative location name below
How would you like to pay? *
Regardless of the method, please make sure your payment is received before the due date or your food will not be ordered. For credit/debit cards, please use this link - https://tinyurl.com/ydyf42ae
ACCESS Card number and PIN
If you do not wish to provide your card number or PIN - or if you wish to pay via cash, check, or credit card - you can visit either of our Greensgrow locations during open hours. If you elect to use your ACCESS card via this online form, we will apply the value of your Philly Food Bucks to your order total. Total monthly cost if using Food Bucks is $40 (meat), $33 (Lg, Veg), and $25 (Sm. Veg).
Your answer
I authorize Greensgrow to charge my ACCESS card for the amount listed above for my selected share type. I understand that, by law, no refunds can be given for purchases made with a SNAP/ACCESS card.
Any other information about your account that you'd like us to know?
Your answer
Submit
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