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2012 CSA Order Form
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2012 Community Supported Agriculture Contract

A completed and signed application form along with payment is required to reserve your space in the program

Please print this page, along with the Terms of Agreement.
Complete and return both pages to us with your payment to:
Pendleton's Country Market, 1446 E. 1850 Rd., Lawrence, KS 66046
NAME _________________________________________________

ADDRESS ____________________________________________

MAIL ________________________ PHONE ___________________
PICK-UP LOCATIONS

Princeton Children's Center
3349 Peterson Rd. (Wednesday Pick-up)

Sunshine Acres Montessori School
2141 Maple Lane (Tuesday Pick-up)

Building Blocks Day Care
1411 E. 1850 Rd. (Tuesday Pick-up)

Pendleton's Country Market
1446 E. 1850 Rd. (Tues. & Wed. Pick-up)
CSA Share Selection
Share
Price
Qty.
Subtotal
OPTION 1. Produce bags delivered to locations for 12 weeks beginning the week of June 4th, 2012. Your first week's drop off will include an insulated reusable tote bag. You will also receive a 10% discount on all plant purchases at the farm during June, July and August.
(Please circle your most convienent drop off location above.)
$180.00
_______
$__________
OPTION 2. Monthly Punch Cards worth $60, that can be used at our farmstand or at the Saturday Lawrence Farmers Market. Each month's card is good for the whole month -- spend as little or as much as you'd like each week. This option allows you to stock up on seasonal items to can or freeze, and it allows you to be gone for a week, and not have to find someone to pick up your share. Cards can be used to buy plants foods, and other items found at Pendleton's Country Maret. Members receive an insulated reusable tote bag, and receive 10% off all plant purchases during the month used.
(Please circle months wanted.)
$60.00
May
June
July
Aug.
Sept.
Oct.
$__________
FALL STORAGE SHARE. One-time pick up, to be picked up at the farm or at the summer pick up locations on November 1st. You will receive a box that could include sweet potatoes, winter squash, turnips, fresh greens and greens that will help feed your family through the holidays and the cold of winter.
$60.00
_______
$__________
Subtotal
$__________

_______
One Payment
Please enclose full payment with your application. We accept cash, checks, VISA, Mastercard and Discover
______
Monthly Payments
If paying by check, please enclose a check for each month, dated 2 months before your bag or punch card membership begins. We will not deposit checks until the date written.
If paying by credit card, we will automatically bill your card 2 monhts before each month of your membership.


PAYMENT PLAN (Please select one.) ____ Check(s) enclosed ____ Please bill my credit card below.

Visa/Mastercard
Name as it appears on your credit card:
Account Number:
Expiration Date:
Security Code#:

Be sure to sign the Terms of Agreement. of this contract and return both pages to us with your payment: Pendleton's Country Market, 1446 E. 1850 Rd., Lawrence, KS 66046