Ann Arbor CSA Membership Form 2012  

Print form, fill out, Enclose Payment, and return to:
Needle-Lane Farms, 6376 Tipton Hwy, Tipton, MI 49287
For information :
e-mail: needlelane@tc3net.com or phone: 517-263-5912

Name_____________________________________                
Phone___________________________________

Address_________________________________________         Cell Phone (Optional)__________________________

City/Zip___________________________________________         E-Mail_____________________________________

Share Selection

_____  $680     Full Season Family Share May-October (20 weeks)

_____  $390     Full Season Single Share May-October (20 weeks)

_____  $474     Summer Season Family Share July-September (12 weeks)

_____  $294     Summer Season Single Share  July-September (12 weeks)

_____  $160    Cut Flower Share  June-September (16 weeks)

_____  $150     Small Market Share-Ypsilanti Depot Town Market  (May-Oct)

_____  $300     Large Market Share-Ypsilanti Depot Town Market  (May-Oct)

Pick-Up Options (Please Check One)

____   Tuesday   After 12 pm at Morgan & York Big Ten Market (1928 Packard St. Ann Arbor MI)

____   Saturday    8am-1pm  Ypsilanti Depot Town Farmers Market


Payment Selection (Please Check One)

_____   Single Payment - Enclose one check for the total amount. (This is best for us if you can swing it.)

_____   2 Installments - Enclose two checks, one with today's date, one dated for deposit on June 1, 2012 (This saves us time and money.)

_____  Pre-Season Deposit - Enclose a $50 non-refundable deposit to hold your membership.   Send the balance or half the balance by April 15. (Paid in full by June 1, 2012)

______ TOTAL DUE

_____  AMOUNT ENCLOSED  

Signature___________________________________

Written receipt of your membership will be acknowledged by mail. This agreement represents a season long contract. Needle-Lane Farms will transfer your share to an individual of your choice if you must terminate your membership

Back to Needle-Lane Farms Home