Application

 Uncle Henry’s Garden /Produce CSA

Application for 2018 Membership:

Name__________________________________________________________________
Address_________________________________________________________________ ________________________________________________________________________
Phone #’s _______________________________________________________________
E-mail__________________________________________________________________
Please list any food allergies or sensitivities that we would need to know about: ________________________________________________________________________

Membership and Payment Options: please circle your choice​
​Family Share: $550/season                                             Regular Share: $350/season

1. Full payment of $550 with application                            1. Full payment of $350 with application

2. Initial payment of $275 with application                          2. Initial payment of $175 with application
        + 1 payment of $275                                                            + 1 payment of $175 
3. Initial payment of $150 with application                           3. Initial payment of $150 with application
        + 4 payments of $100/month                                               + 2 payments of $100/month

4. Initial payment of $150 with application                            4. Initial payment of $150 with application
        + 8 Payments of $50/month                                                 + 4 payments of $50/month

Send form and full/ initial payment to: “Uncle Henry’s Garden”, 749 S.5th St., Indiana, PA 15701
Additional payments begin the following month.Please sign below. Your signature indicates your understanding of and agreement with
the following statements:

Membership in our CSA represents your commitment to the future of local, sustainable agriculture. There are rewards, responsibilities, and risks associated with farming. As a CSA Member, you share the rewards in form of our produce harvest, but you will also share some of the responsibilities, and risks with us, the farmers.

Uncle Henry’s Garden CSA assumes responsibility for providing its members with a minimum of 20 weekly shares of fresh produce, grown on our farm with non-chemical sustainable methods and materials. While amounts may vary from week to week, we pledge to provide value that meets or exceeds the value of your membership payments.

Uncle Henry’s Garden CSA Members assume the responsibility for picking up their weekly shares at the designated time and place. Pick-up locations: Indiana, PA, +TBA. Members also assume the risk that one or another of our crops might be unavailable due to weather or other conditions.

Signature of CSA Member: ___________________________________________________ 

Downloads

Membership Application (pdf)

Download