Misty Meadows Farm CSA
2010 Payment Form
Name:__________________________________________________________________
Address:________________________________________________________________
City:___________________________________________________________________
Phone Numbers: day_____________ evening_____________cell____________________
Email:__________________________________________________________________
Names and emails of people that may pick up for you:______________________________
Please choose only one:
Tuesday boxed pickup at Phoenix Hill FM_____________or
Thursday boxed pickup at one of these Louisville drop sites:
#1 Rockingham Road, Prospect________
#2 Kennison Ave, Louisville_________
#3 Carlton Terrace, Louisville_________
#4 S. 6th Street, Louisville__________
#5 Union Ave, Louisville___________
#6 Genscape, Louisville___________(this location by invitation only)
Annual Fee (20 weeks) $600 Full Share--------------------------------___________
Annual Fee (20 weeks) $325 Half Share-------------------------------___________
Anticipated 1st session start: Mid May; anticipated 2nd session start: Mid August
If not paying annual fee:
1 session (10 weeks) $325 Full Share---------------------------------------___________
1 session (10 weeks) $175 Half Share--------------------------------------___________
2 session (10 weeks) $325 Full Share---------------------------------------___________
2 session (10 weeks) $175 Half Share--------------------------------------___________
Payment plans available upon request.
November 2010 CSA: 4 weeks $100. This option available for purchase Sept. 2010.
Please copy and print this page and mail completed form along with payment to:
Misty Meadows Farm
PO Box 89
Payneville KY 40157
