Sign Up for Farm Share


Farm Share Sign Ups are now open.  Complete the form below, or if you prefer you can mail in a hard copy. Printable links available at the bottom of the page.

 

VINES Farm Share Agreement

  • Farm Share Communication Preferences

    If so, please select your interest(s)
  • Pick-Up Locations

  • Interested in Pilot Home Delivery Program?

    Limited mobility or access to transportation? Small children at home? Too far from a distribution site (more than .5 mile)? Check below to show interest in program.
    If I check this box, the Farm Share Manager will call to discuss application.
  • Farm and Size Options

    Please select one or more farm share(s): *prices listed are before discount* PLEASE BE SURE YOUR SHARE CAN BE PICKED UP AT YOUR SELECTED LOCATION.
  • WAITLIST ONLY!!!!! IF YOU PICK THIS CHOICE YOU WILL BE PUT ON A WAITING LIST. Please choose another share in the meantime! Pick up Thursdays at BUF, Lee Barta, Lourdes, TAB or UPC sites.
  • Pick up Wednesdays: Roosevelt Elem, Southside, Family Enrichment Network, or Rural Health Network Pick up Thursdays: Central United Methodist and Lee Barta Community Center
  • Pick up Thursdays at CUMC, Lourdes, TAB, UPC or Whitney Point sites.
  • Check all that apply:
  • Payment Infomation

  • NEW DISCOUNT AVAILABLE. In addition to our customers who receive SNAP, WIC or meet income guidelines being able to receive a 25% or 50% discount on share prices while funding is available, we now also have a 75% discount for those with level 1 income according to the attached table. Discount is applied on a first-come, first-served basis.
  • Use the chart below to find your family size and go across the row and tell us your income

    (We encourage everyone to complete this section. It must be completed by discount recipients)
  • In the chart above, find the total number of family members living in your household. Follow the row across to find your income level.
  • Applicant Information

    All personal information will be kept confidential. We use this information to track our success in serving a diverse range of customers. Only income level will determine discount.
  • By signing below, I declare that the above information is true and correct to the best of my knowledge and I understand and agree to the policies of the Farm Share Program.

    Policies can be found at www.tinyurl.com/fspolicies
  • Date Format: MM slash DD slash YYYY

Single-sided agreement

Double-sided agreement