2019 CSA SIGN UP ORDER FORM 2019 LOTFOTL CSA 2019 CSA Registration Form Name *FirstLastEmail *This is where your confirmation email, payment directions, and newsletters will be sent, REGARDLESS OF WHATEVER EMAIL IS ASSOCIATED WITH YOUR LOTFOTL ACCOUNT.Phone *Address (If you choose a home delivery program this is where the food will be delivered) *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWhat CSA program would you like to sign up for? Note if you want home delivery choose that in this section. *CHOOSE AN OPTIONCHOICE FULL SPECTRUM- Prorated pricing will applyCHOICE MEATLESS - Prorated pricing will applyCHOICE PRODUCE ONLY- Prorated pricing will applyCLOSED FOR 2019 - SATURDAY MARKET CHOICE PRODUCE ONLY CLOSED FOR 2019 - BOX PROGRAM (traditional style)CLOSED FOR 2019 - CHOICE HOME DELIVERY PROGRAM- CLOSED FOR THE SEASON - Prorated pricing will applyCHOICE HOME DELIVERY MONTHLY ONLY MEAT (3 DELIVERIES)I understand that due to the nature of this program, where members get to choose what and how many items they need for the week, I must register ALL household members in the program. Registering 1 person in a multiperson household would compromise both the farm and the program. *YES, I understand that I must register All household members Number of FULL SPECTRUM Senior Adults in your family (age 65 and up). Include yourself if applicable (FS) (Single Payment) *NONE1 Senior Adult ($43/wk) (FS)2 Senior Adult ($86/wk) (FS)Number of FULL SPECTRUM Adults in your family (ages 18 to 64). Include yourself if applicable (FS) (Single Payments) *NONE1 Adult ($52/wk) (FS)2 Adult ($104/wk) (FS)3 Adult ($156/wk) (FS)Number of FULL SPECTRUM Children in your family (ages 11-17). (FS) (Single Payments) *NONE1 Child 11-17 ($26/wk) (FS)2 Child 11-17 ($52/wk) (FS)3 Child 11-17 ($78/wk) (FS)Number of FULL SPECTRUM Children in your family (ages 5-10). (FS) (Single Payments) *NONE1 Child 5-10 ($13/wk) (FS)2 Child 5-10 ($26/wk) (FS)3 Child 5-10 ($39/wk) (FS)Number of MEATLESS Senior Adults in your family (age 65 and up). Include yourself if applicable (NM) (Single Payments) *NONE (NM)1 Senior Adult ($30/wk) (NM)2 Senior Adult ($60/wk) (NM)Number of MEATLESS Adults in your family (ages 18 to 64). Include yourself if applicable (NM) (Single Payments) *NONE (NM)1 Adult ($36/wk) (NM)2 Adult ($72/wk) (NM)Number of MEATLESS Children in your family (ages 11-17). (NM) (Price is based on six monthly payments) (Single Payments) *NONE (NM)1 Child 11-17 ($18/wk) (NM)2 Child 11-17 ($36/wk) (NM)3 Child 11-17 ($54/wk) (NM)Number of MEATLESS Children in your family (ages 5-10). (NM) (Single Payments) *NONE (NM)1 Child 5-10 ($9/wk) (NM)2 Child 5-10 ($18/wk) (NM)3 Child 5-10 ($27/wk) (NM)Number of PRODUCE ONLY Senior Adults in your family (age 65 and up). Include yourself if applicable (P) (Single Payments) NONE (P)1 Senior Adult ($18/wk) (P)2 Senior Adult ($36/wk) (P)Number of PRODUCE ONLY Adults in your family (ages 18 to 64). Include yourself if applicable (P) (Single Payments) *NONE (P)1 Adult ($22/wk) (P)2 Adult ($44/wk) (P)3 Adult ($66/wk) (P)Number of PRODUCE ONLY Children in your family (ages 11-17). (P) (Single Payments) *NONE (P)1 Child 11-17 ($11/wk) (P)2 Child 11-17 ($22/wk) (P)3 Child 11-17 ($33/wk) (P)Number of PRODUCE ONLY Children in your family (ages 5-10). (P) (Single Payments) *NONE (P)1 Child 5-10 ($5.50/wk) (P)2 Child 5-10 ($11/wk) (P)3 Child 5-10 ($16.50/wk) (P)Which CHOICE dropsite will you be picking up at? Items will be chosen directly from our delivery vehicle. It is like a farmers market on wheels. *TUESDAY- 2:30-4:00pm UEC (Riverside Park)TUESDAY- 5:00-7pm Bay View (Garden District)THURSDAY - 6:30-8pm Pewaukee (Good Harvest Market)THURSDAY- 4-6pm New Berlin (GMR)SATURDAY 8:30-10am Shorewood Capital Dr.SATURDAY 10:30-12pm Bay View (Garden District)) Which dropsite will you be picking up at? Items are prepacked and ready to go. *SITE CLOSED - TUESDAY- 2:30-4pm UEC (Riverside Park)SITE CLOSED TUESDAY- 5-7pm Bay View (Garden District)SITE CLOSED THURSDAY - 1:30-3pm Pewaukee (Good Harvest Market)SITE CLOSED THURSDAY- 4-6pm New Berlin (GMR)SITE CLOSED SATURDAY 8:30-10am Shorewood Capital Dr.SITE CLOSED SATURDAY 10:30-12pm Bay View (Garden District)) SITE CLOSED THURSDAY - 1-8pm Elkhorn (Quinney Rd) (This dropsite will be self-serve from the walk-in coolerThe traditional style boxed CSA program has gone through some changes this year. Especially if you were a past particpant these will be important to note. Please check that you are aware of the following changes.The drops sites have specific pick up times and are no longer self-serveOur vacation hold policy has been dropped. For those that need more flexibility, take a look at our CHOICE programBoxes will have 7-10 items each week, but not set published contents, so what you get will be a bit more of a surpriseWeekly Market Produce (6-7 items) (Single Payments) *CHOOSE AN OPTIONWEEKLY MARKET PRODUCE (17 deliveries)Prepacked traditional style CSA box (Single Payments) *CHOOSE AN ITEMQTY 1 - BI-WEEKLY (10 boxes total in a 20 week season)QTY 2 - BI-WEEKLY (10 boxes total in a 20 week season)This box is prepacked and contents are chosen by the farmer. You get to be surprised each week when you open the box.Home Delivery CHOICE MONTHLY MEAT (3 MONTHS) (Single Payments) *CHOOSE AN ITEM3 month (May-July)3 month (Aug-Oct)6 month (May- Oct)You choose $100 worth of meat each month. $5/month goes to a delivery fee.Instead of home delivery for my meat share please deliver it to: Thursday 4-6pm – New Berlin – GMR MarketingThursday 6:30-8pm -- Pewaukee – Good Harvest MarketThursday 1-8pm – Elkhorn - LotFotL Community Farm (Quinney Rd) I prefer the home delivery optionWhich HOME DELIVERY program would you like to choose? *CLOSED FOR THE SEASON - CHOICE FULL SPECTRUMCLOSED FOR THE SEASON - CHOICE MEATLESSCLOSED FOR THE SEASON - CHOICE PRODUCE ONLYNumber of FULL SPECTRUM Senior Adults in your family (age 65 and up). Include yourself if applicable (FS) (HD) (Single Payments) *NONE (FS) (HD)1 Senior Adult ($43/wk) (FS) (HD)2 Senior Adult ($86/wk) (FS) (HD)Number of FULL SPECTRUM Adults in your family (ages 18 to 64). Include yourself if applicable (FS) (HD) (Single Payments) *NONE (FS) (HD)1 Adult ($52/wk) (FS) (HD)2 Adult ($104/wk) (FS) (HD)3 Adult ($156/wk) (FS) (HD)Number of FULL SPECTRUM Children in your family (ages 11-17). (FS) (HD) (Single Payments) *NONE (FS) (HD)1 Child 11-17 ($26/wk) (FS) (HD)2 Child 11-17 ($52/wk) (FS) (HD)3 Child 11-17 ($78/wk) (FS) (HD)Number of FULL SPECTRUM Children in your family (ages 5-10). (FS) (HD) (Single Payments) *NONE (FS) (HD)1 Child 5-10 ($13/wk) (FS) (HD)2 Child 5-10 ($26/wk) (FS) (HD)3 Child 5-10 ($39/wk) (FS) (HD)Number of MEATLESS Senior Adults in your family (age 65 and up). Include yourself if applicable (NM) (HD) (Single Payments) *NONE (NM) (HD)1 Senior Adult ($30/wk) (NM) (HD)2 Senior Adult ($60/wk) (NM) (HD)Number of MEATLESS Adults in your family (ages 18 to 64). Include yourself if applicable (NM) (HD) (Single Payments) *NONE (NM) (HD)1 Adult ($36/wk) (NM) (HD)2 Adult ($72/wk) (NM) (HD)Number of MEATLESS Children in your family (ages 11-17). (NM) (HD) (Single Payments) *NONE (NM) (HD)1 Child 11-17 ($18/wk) (NM)2 Child 11-17 ($36/wk) (NM)3 Child 11-17 ($54/wk) (NM)Number of MEATLESS Children in your family (ages 5-10). (NM) (HD) (Single Payments) *NONE (NM) (HD)1 Child 5-10 ($9/wk) (NM) (HD)2 Child 5-10 ($18/wk) (NM) (HD)3 Child 5-10 ($27/wk) (NM) (HD)Number of PRODUCE ONLY Senior Adults in your family (age 65 and up). Include yourself if applicable (P) (HD) (Single Payments) *NONE (P) (HD)1 Senior Adult ($18/wk) (P) (HD)2 Senior Adult ($36/wk) (P) (HD)Number of PRODUCE ONLY Adults in your family (ages 18 to 64). Include yourself if applicable (P) (HD) (Single Payments) *NONE (P) (HD)1 Adult ($22/wk) (P) (HD)2 Adult ($44/wk) (P) (HD)3 Adults ($66/wk) (P) (HD)Number of PRODUCE ONLY Children in your family (ages 11-17). (P) (HD) (Single Payments) *NONE (P) (HD)1 Child 11-17 ($11/wk) (P) (HD)2 Child 11-17 ($22/wk) (P) (HD)3 Child 11-17 ($33/wk) (P) (HD)Number of PRODUCE ONLY Children in your family (ages 5-10). (P) (HD) (Single Payments) *NONE (P) (HD)1 Child 5-10 ($5.50/wk) (P) (HD)2 Child 5-10 ($11/wk) (P) (HD)3 Child 5-10 ($16.50/wk) (P) (HD)Home Delivery Premium (Single Payments) *$7.70 weekly delivery feeThe home delivery package requires an additional delivery fee of $7.70/wk. A total of $200 for the season.What home delivery day works best? *CLOSED FOR THE SEASON - TUESDAY: I live in Milwaukee in one of the following zip codes ( 53206, 53110, 53129, 53201, 53202, 53204, 53205, 53207, 53208, 53209, 53210, 53211, 53212, 53213, 53215, 53216, 53217, 53218, 53219, 53220, 53221, 53228, 53233, 53235, 53222, 53223)CLOSED FOR THE SEASON - SATURDAY: I live in Milwaukee in one of the following zip codes (53206, 53110, 53129, 53201, 53202, 53204, 53205, 53207, 53208, 53209, 53210, 53211, 53212, 53213, 53215, 53216, 53217, 53218, 53219, 53220, 53221, 53228, 53233, 53235, 53222, 53223)CLOSED FOR THE SEASON - ???: My zip code is not listed, but I am interested in the program. Please contact me to discuss options.CHOICE: I understand that I will be invoiced for the total amount due via EMAIL, and I can choose to pay all at once with check or credit card, or pay a $450 deposit and schedule 6 monthly payments. *Yes, I will be sending a check for the full amountYes, I will send a deposit check dated today for $450, in addition to 6 additional post dated checks to be cashed one per month starting in May-October. (see payment estimation directions below)Yes, I will be paying all at once with my credit/debit cardYes, I will be setting up AUTOMATED monthly payments (see payment estimation directions below) *****To estimate your payment amount, take the total amount due minus $450 deposit divided by 6 monthly paymentsSATURDAY MARKET: I understand that I will be invoiced for the total amount due via EMAIL, and I can choose to pay all at once with check or credit card, or pay a $150 deposit and schedule 5 automated monthly payments. *Yes, I will be sending a check for the full amountYes, I will send a deposit check dated today for $150, in addition to 5 additional post dated checks to be cashed one per month starting in June -October. (see payment estimation directions below)Yes, I will be paying all at once with my credit/debit cardYes, I will be setting up AUTOMATED monthly payments (see payment estimation directions below) *****To estimate your payment amount, take the total amount due minus $150 deposit divided by 5 monthly paymentsBOX PROGRAM : I understand that I will be invoiced for the total amount due via EMAIL, and I can choose to pay all at once with check or credit card, or pay a $150 deposit and schedule 5 automated monthly payments. *Yes, I will be sending a check for the full amountYes, I will send a deposit check dated today for $150, in addition to 5 additional post dated checks to be cashed one per month starting in June -October. (see payment estimation directions below)Yes, I will be paying all at once with my credit/debit cardYes, I will be setting up AUTOMATED monthly payments (see payment estimation directions below) *****To estimate your payment amount, take the total amount due minus $150 deposit divided by 5 monthly paymentsMEAT ONLY: I understand that I will be invoiced for the total amount due via EMAIL, and I can choose to pay all at once with check or credit card, or pay a $125 deposit and schedule 3 monthly payments. *Yes, I will be sending a check for the full amountYes, I will send a deposit check dated today for $125, in addition to 3 additional post dated checks to be cashed one per month during the 3 months that you will receive delivery. (see payment estimation directions below)Yes, I will be paying all at once with my credit cardYes, I will be setting up AUTOMATED monthly payments (see payment estimation directions below) *****To estimate your payment amount, take the total amount due minus $125deposit divided by 3 monthly paymentsI have read and agree to the LotfotL terms and conditions (view link below) *Yes. I read the conditions and took note of everything including the cancelation policy.Please tell us how you found LotFotL Community FarmTotal$ 0.00WebsiteSubmit Make sure to click on Submit.