La Cosecha Community Supported Agriculture Application Form – Half Share

2016 Contact Info: Name(s):

Mailing Address:

Zip Code:

Cell Phone:

Home Phone:

E-mail:

How did you hear about La Cosecha CSA? ___

___________________________ Have you participated in La Cosecha CSA before? _

_ If so, when? _

______ Does your household meet income eligibility for SNAP: Yes No Not Sure How many children (0-18) are in your household? _

_ How old are they? __

_ What school do they go to? ___

________________________________________

Community Supported Agriculture (CSA) Agreement: I agree to join La Cosecha CSA for the full 20-week season (June 15th- October 27th, 2016) and to pay a deposit of $15 to secure my spot in the CSA. I understand that my CSA share is dispersed on a weekly basis and I am committed to paying for the full 20-week season even if I am unable to pick up my CSA bag on a given week. If I skip 2 weeks without communicating with CSA staff, I understand that my membership will be suspended without a refund.

I am responsible for picking up my CSA share each week at the prearranged location, and I understand that no refunds will be given for weekly shares not picked up during designated times. If for some reason I need to skip a week, I will notify La Cosecha CSA staff at least 1 week prior so that donation of the CSA share can be arranged. Pick up location and time will be confirmed before La Cosecha CSA begins on June 15th, 2016.

I understand that being a part of a CSA means that I am supporting local farmers. While La Cosecha CSA’s farmers are committed to delivering a variety of locally grown produce each week, the timing, quality and quantity of produce may vary depending on a number of factors (weather etc.). I understand that the risks of farming may occasionally reduce the CSA share.

I agree to pay the equivalent of $15* per week for 20 weeks for one half size CSA share for the 2016 season. Payments can be made to the Agri-Cultura Network by cash, check, credit card, or EBT (see next page for payment details).

Printed Name:

Signed:

Dated:

Please contact info@LaCosechaCSA.org with any questions.

La Cosecha Community Supported Agriculture Application Form – Half Share

2016

Pick-Up Location:

Wednesdays at South Valley Pick-up Site Thursdays at UNM Pick-up Site

Payment Info:

*We require a deposit of $15 to be paid by June 1st to secure your CSA membership. Deposits should be submitted with your application and will be applied towards payment for the final week of the CSA. We encourage CSA members to pay in full at the start of the season, if possible. If you are unable to pay in full at the start of the season, we are happy to accept multiple payments over the course of the season with the addition of a minimal fee to cover the cost of our payment processing expenses (see payment options below). Checks should be addressed to: “Agri-Cultura Network” (with “La Cosecha CSA” written on the memo). Payments can be sent to: Agri-Cultura Network, 318 Isleta Blvd SW, ABQ, NM, 87105.

Please check your preferred method of payment:

Cash Check Credit Card EBT Please check your preferred payment schedule:

$15 deposit (paid by June 1st) + one payment of $285 (paid by June 15th)

$15 deposit (paid by June 1st) + two payments of $142.50 + processing fee of $3/pmnt (paid by June 15th & August 17th)

$15 deposit (paid by June 1st) + five payments of $57 + processing fee of $3/pmnt (paid by the 15th of each month beginning in June) La Cosecha Donations:

In order to make La Cosecha CSA produce more available to low-income households we accept donations to help subsidize CSA boxes and increase access to locally grown, healthy food in our community. Every little bit helps! Tax-deductible donations can be made out to the RGCDC (our fiscal sponsor), and sent to: Agri-Cultura Network, 318 Isleta Blvd. SW, ABQ, NM 87105. Please note “La Cosecha Donation” in the memo.

I would like to help low-income families participate in La Cosecha CSA by making an additional (check one):

One-time donation of: $

5 monthly donations of: $

Signed:

Dated: