| First Name * |
|
| Last Name * |
|
| Email * |
|
| Address * |
|
| City * |
|
| ZIP * |
|
| Phone * |
|
| I want to
have a: * |
Regular Size Box ($25) Buellton
Members Only
Regular
size box ($20)
|
| Pick up, Drop off
or Delivery* |
I want to pick up my
box. (Please write below where.)
I want to be
a
drop off site (Please write
location below).
I want to
have
delivery. (Please write below where.) |
| Payment Plan* |
I will prepay for the
whole year.
I will
prepay every three months (4) installments.
I will
prepay
monthly.
(If you want to be bi-monthly or once a month please indicate that
below on additional message. |
| Additional Message: |
|
| *
Are required fields |
| With
submitting this form, I agree to pay in full by the stated payment dates.
I
understand that the harvest projections are estimates which may vary
within the season. |
|
