Farm Share Communication Preferences
If so, please select your interest(s)
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:
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
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.
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