BEULAHLAND FARM
2008 20 WEEK CSA SUBSCRIPTION FORM
(Please print legibly or type)
NAME(S)_______________________________________________________________
ADDRESS______________________________________________________________
CITY/STATE/ZIP_________________________________________________________
HOME PHONE__________________________________________________________
WORK PHONE__________________________________________________________
CELL PHONE___________________________________________________________
E-MAIL________________________________________________________________
I WILL PICK UP MY SUBSCRIPTION EACH SATURDAY AT (Choose One):
____ The Omaha Farmers Market, 11th & Jackson, in the Old Market.
____ The Village Pointe Farmers Market, 168 & West Dodge Rd.
PAYMENT:
____$500.00 full subscription payment enclosed.
____$100.00 non-refundable deposit enclosed ($400.00 balance due by May 1, 2008).
____$ 80.00 additional dozen egg subscription (due by May 1, 2008).
____$ 40.00 additional half-dozen egg subscription (due by May 1, 2008).
Total Enclosed $__________
I have read and understand the Subscriber – Grower Agreement 2008 and hereby agree to its terms.
_____________________________________________________________________________
Subscriber Signature
Mail checks payable to Beulahland Farm to:
Victor Novak
Beulahland Farm
2011 County Rd. Q
Lyons, NE 68038