Join Provident Organic Farm--2005
Please return this form with your deposit
****************************************************************************************************
NAME:_______________________________________________________________________
ADDRESS:____________________________________________________________________
______________________________________________________________________________
PHONE:
______________________________________________________________________
E-MAIL:______________________________________________________________________
On the
reverse side, please list the contact information of the other individuals or
families participating in your membership.
1)
PICK
UP LOCATION (CHOOSE ONE):
a.
BERLIN (Farmers’ Market on Fridays)
b.
FARM (Tuesdays)
c.
South
SALISBURY (206 Kay Avenue on Tuesdays)
d.
Central SALISBURY (924 N. Division on Fridays)
e.
EASTON (405 S. Washington Street,
Farmers’ Market on Saturdays )
2)
MEMBERSHIP
___Working
share $475
___Non-working share $575
3)
PAYMENT
A
$75 non-refundable deposit along with this completed form will confirm your
share.
_____Full
Payment: You may pay in full for the entire season by April 1, 2004
_____Working Share Payment Plan: By January 31, 2005--$75
Deposit; February 1, 2005--$100, March 1, 2005--$100, April 1, 2005--$100; May
1, 2005--$100
_____Non-Working Share Payment Plan: By January 31,
2005--$75 Deposit; February 1, 2005--$100, March 1, 2005--$100, April 1,
2005--$150; May 1, 2005--$150
If paying by credit card please
provide the following:
___American Express
___Master Card
____Visa
Card Number:
___________________________________________________________
Expiration Date:
__________________________________________________________
Name as it appears on the credit
card: _________________________________________
There is a 5% additional handling fee associated with payment by credit card.
Make
checks payable to Jay Martin and mail to
Provident
Organic Farm
P.O.
Box 62
Bivalve,
MD 21814
THANK YOU!