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, 11^th & 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.

Mail checks payable to Beulahland Farm to:

Victor Novak
Beulahland Farm
2011 County Rd. Q
Lyons, NE 68038