| First Name * |
|
| Last Name * |
|
| Email * |
|
| Address * |
|
| City * |
|
| ZIP * |
|
| Phone * |
|
| I want to
have a: * |
Regular size box ($20)
|
| Pick up, Drop off
or Delivery* |
I want to pick up my
box.
I want to be a drop off site (please write
location below).
I want to have delivery. |
| Payment Plan* |
I will prepay for the
whole year.
I will prepay in three months installments.
I will prepay monthly. |
| 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. |
|
