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Name:__________________________________

Address:_____________________

City__________ Zip__________

Phone:________________

Email: ________________

Please check off your option:

Pickup: Full Payment $435 Payment Plan $77 (five more monthly payments are due starting in June.)

Stick & Stone Farm Wed. 2-7pm

Three Swallows Farm Sat. 10-3pm

While we ask that you select a primary pickup site, you are welcome to pickup from the other farm on occasion. Please let our coordinator Melissa know if you plan to switch pickups.

Delivery:

Full Payment $525

Payment Plan $95 (five more monthly payments are due starting in June.)

Group Delivery $475 Group Delivery Location Name:__________

Group Delivery Payment Plan $85 (five more monthly payments are due starting in June.)

Delivery Address (if different than above):

___________________

___________________

Delivery Phone #:

___________

Donations:

Help fund low-income shares! This is an important way we can make food available to more people. Any donation is welcome. ____amount

Please write all checks to:

Full Plate Farm Collective

P.O. Box 6898
Ithaca, N.Y. 14851