2021 CSA Full Share

2021 CSA Half Share


CSA MEMBERSHIP FORM INFORMATION
Note: If paying by check or credit card – please include the following information.


Mail information and check to:
Wholistic Farms – Shane Whitmire
9870 Post Road – Shady Dale, GA  31085

Name:_______________________________________________

Mailing Address:____________________________________

Phone Number:_____________________________________

Email Address: _____________________________________

Payment Method: Check – Credit Card – PayPal
Credit Card Number:________________________________
Expiration Date: ______________
Security number on back of card:_______

Payment Amount (pick one): Full $702.00    Half Share $390.00

Preferred pick up day: (pick one): Saturday           Wednesday
How did you hear about us?______________________________________