Uncle Henry's Garden

Uncle Henry’s Garden
Produce CSA
Application For Membership



Phone #’s ____________________________________      ________________________________________________

Email _________________________________________________________________________________________

Please list any food allergies or sensitivities that we would need to know about
Membership Cost is $550 per season for the Family Share, and $350 per season for the Regular Share.
This covers a minimum of 20 weekly produce deliveries.
Payment Plan – Indicate your choice:
Full payment included with application________________________________
4 Monthly – First payment of $100 included___________________________
10 Monthly – First Payment of $50 included____________________________
Other, please specify and include initial payment_______________________
Please sign below. Your signature indicates your understanding of and agreement with the following statement:

Membership in our CSA represents your commitment to the future of local, sustainable agriculture. There are rewards, responsibilities, and risks associated with farming. When I sell food at our local market, I enjoy all of these myself. Membership entitles you to experience the rewards, responsibilities, and risks along with me.
Uncle Henry’s Garden CSA assumes responsibility for providing its members with a minimum of 20 weekly deliveries of fresh produce, grown on our farm with non-chemical sustainable methods and materials. While amounts may vary from week to week, we pledge to provide value that meets or exceeds the value of your membership payments.
Uncle Henry’s Garden CSA Members assume the responsibility for picking up their weekly shares at the designated time and place (either at our home or at the local Farmer’s Market). Members also assume the risk that one or another of our crops might be unavailable due to weather or other conditions.
Signature of member__________________________________________________________________



Click on the blue button to the right to download an application form that you see below.

Print the form and send with payment to:

Uncle Henry's Garden

c/o Stanley Chepaitis

749 South 5th Street

Indiana, PA 15701