2017

CSA –Your Way Program

Sign-up Form

Send payments to: Paul Mazza’s, 135 Poor Farm Road, Colchester, VT 05446

Name: ___________________________________ Mailing Address: ____________________________________

Mailing Address for the cards (if different from above): ______________________________________________ ___________________________________________________________________________________________

Additional Names (if you joined with someone – please specify amounts on each card):

E-Mail Address (or addresses of everyone who would like to receive weekly CSA emails):

____________________________________________________________________________________________________________________________________________________________________________________________________

Share Size:

Single/Senior $290.00_____________

Small $390.00______________

Large $540.00______________

Referred by (if someone told you about our CSA Programs) or how did you hear about us?

________________________________________________________________________________________________

Thank you for your continued support! We look forward to seeing you at the farm!

Office use only:

Received Date: _________________

Check #: _______________________

Amount: _______________________

Share size: ______________________