Apple Hill Farm
2017 CSA- Community Supported Agriculture Form
                                                                    Print this form, fill it out then mail
                                                                  or you can bring it with your payment to:
                                                                                   Apple Hill Farm
                                                                                  580 Mountain Rd.
                                                                              Concord, N.H. 03301
Name: _______________________________________
Phone: _______________________________________

This CSA share will be valid for the 2017 season at Apple Hill Farm.  The CSA card will        
be valid for purchase of any produce item grown or raised on our farm. Any balance left      
on the card as of November  23, 2017 will be null and void of any value after our farm         
stand closes for the 2017 season.  I have read and understand these terms.

Signature: _________________________________________________
You Choose Your Share Amount

Share Amount:  $_____________   Minimum Share ($150.00)
* Apple Hill Farm will add 10% extra value on your CSA card at your time of initial issue or
at                added value when you recharge the card*
Payment Type: Credit Card / Check / Cash (please circle)
Credit Card: Type: MC / Visa (please circle)       Or Check # :

Card #: ______________________________     Exp date: __________

Signature: _________________________Date: ________
Mail Payment to: Apple Hill Farm, 580 Mountain Rd. Concord, N.H. 03301
Below filled out at Farm upon Debit Card pick up

Card # _______________________ Issued by ___________ Date _______