Agric Organic - 2022 SNAP CSA Pilot Membership Agreement

Community Supported Agriculture (CSA) programs provide SNAP customers with fresh, nutritious fruits and vegetables while supporting local farmers. DTA, Project Bread and Agric Organic work together to offer SNAP customers an easy way to pay for these fruits and vegetables, which are called CSA shares. Participating in a CSA, allows SNAP customers to get fresh produce, support local farmers and save money!

CSA Partner Contact Information

Name: Agric Organics

Address: 84 Washington Road

                Wilbraham, MA 01095

Email: agricorganicsfarm@gmail.com

Phone: 413-279-4115

 

SNAP Customer Contact Information (Head of Household or Authorized Rep. only- Please print)

Last digit of SNAP Customer's SSN# or the last digit of client's temporary 999 identification number.

Note: The 999 number is assigned by DTA and only acceptable if the client does not have a valid SSN:

I. Monthly cost of a SNAP CSA share

I am interested in buying a SNAP CSA share from Agric Organic.

II. I understand that:

• The amount I agreed to above will be automatically deducted from my EBT account on the date that  I  receive my SNAP benefits.

• It is my responsibility to pick up my share on my scheduled pick-up date, during the scheduled pick-up
• If I cannot pick up my share, it is my responsibility to have someone to pick it up for me. If I do not pick up my share during my scheduled pick-up time, it will be donated to a local food
• pantry, shelter, or other institution that will make use of the produce and I will not get a refund.
• The types of produce in my share will change weekly. There is no guarantee on the exact amount of produce. Shares will vary in weight, size and type of produce.
• I cannot return my CSA share for a refund or exchange it for other produce.
• I can cancel my participation in the pilot at any time. If I no longer want to participate, I will ask Farm
• staff or email DTA.CSA@MassMail.State.MA.US for a cancellation form.
• I will complete and return the form to Agric Organic at least 10 days before I receive my next monthly
• If I do not return the completed form at least 10 days before that date, my CSA share payment may automatically be deducted from my next SNAP benefit. In that case, the cancellation will take effect the following month. I understand that Agric Organic and DTA will act on my request to cancel my payment as soon as possible. I understand that I will not receive a refund for CSA share payments that have already been deducted. I agree to participate in a brief survey about this SNAP CSA Pilot at the beginning and end of the CSA
• My copy of this agreement, and the notices I will receive each time a payment is deducted from my SNAP EBT account, will serve as receipt of payment.

Return form to: Agric Organics