Apple Hill Farm
2013 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: _______________________________________
Address:_____________________________________
Phone: _______________________________________
Email:________________________________________
This CSA share will be valid for the 2013 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 27, 2013 will be null and void of any value after our farm
stand closes for the 2013 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 _______