2017 CSA Online Application

20 or 29 Weekly Deliveries of Vegetables, Herbs and Eggs
May 16-December 9, 2017

New MemberReturning Member
Primary Member First and Last Name (required)

Address (required)

City, State and Zip (required)

Primary Member Emails (required). List emails of all members who want the weekly bag notes.

Area Code + Phone (required)

Secondary Member First and Last Name*
(*If Separate Household)


City, State and Zip

Secondary Member Email

Area Code + Phone

Full Season20-Week Season (required)  
Full Season Shares
Choose your share size
20-Week Season Shares
Choose your share size
Indicate what you will pay for selected share (required)
Click here to learn more about selecting a sliding scale price.
Additional Shares (please select all that apply)
Choose your herb share:
Choose your egg share:

Number of dozen per week, if more than 1:

Organically Grown Cotton T-shirts ($22 ea - indicate size below)
Women's SmallWomen's MediumWomen's Large
Men's SmallMen's Medium

1) Subtotal for selections above (required)
2) Payment Option(choose one)

3) Check here to deduct $15 if paying in full -$15
4) Amount of payment now (required)
If not paying in full, your first payment will be billed upon receipt of your deposit.
New members (minimum 50% of subtotal)*
How did you hear about us?
Returning members (minimum $100 deposit)*
5) Check here if you want to receive a discount on your share from our Neighbors Help Neighbors fund yes!

* Please mail your deposit or payment in full to Seven Springs CSA | PO box 320 | Floyd, VA 24091

Delivery Site (choose one)
Weekly Note (choose one)

By submitting this form I agree to the Farm Policy. *

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