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.

Total Enclosed_____________

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.

                                                    Formal Agreement

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    

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