Rare Earth Farm 2013 Agreement Form
Complete this form and return it with your payment to the address printed below. A confirmation
letter will be mailed out to you immediately upon our receiving this form.
Important! Please contact us if you don't receive this letter within 10 days after mailing this information.
*On the back of this form if this is your first season please tell us how you discovered us. (Newspaper ads,
referred by another subscriber, facebook, or specify other source.)
Name Please Print Date Phone No. (required)
Street City Zip Preferred drop-off
e-mail address: ____________________________________ New Member
(e-mail address required to receive weekly newsletters) Returning Member
Check the appropriate box(s)
I would like to receive one share of the 2013 vegetable harvest. Enclosed is $565.00.
I would like to receive one share of the 2013 vegetable harvest. Enclosed is $282.50 and I
agree to send the second payment of $282.50 by May 31st.
I would like to receive along with my vegetable share, one dozen eggs every week totaling
21 dozen for the season. Enclosed is $78.75 plus my payment for the vegetable share.
I would like to receive along with my vegetable share, one dozen eggs every other week totaling
12 dozen for the season. Enclosed is $45.00 plus my payment for the vegetable share.
Note for those splitting shares: It is not necessary for us to have both parties names assigned to one
membership. The name as it appears at the top of this form will be the only name entered into our database
records. Consolidate and make any group payments with one check only and clearly identify the primary
shareholder's name on it.
** If you choose to make a partial payment, your final payment needs to be received by May 31st to stay enrolled in the program.
I want to participate in the 2013 CSA program at Rare Earth Farm. In submission of this form I accept all conditions and terms of this program. As a subscription member I fully accept sharing the risk of crop failure from all factors beyond the farmers control knowing it may affect the availability of certain crops and the amounts that I'll receive throughout the season.
Make checks payable and return to: Rare Earth Farm
c/o Steve Young
6806 Hwy KW
Belgium, WI 53004