Apple CSA Enrollment Form

Juli's Applesauce and Apple Butter

Optionally, order Juli's applesauce and apple butter, made from our organic apples without added sugar.
Would you like to receive applesauce or apple butter with your deliveries?

Yes, I would like applesauce and/or apple butter every four weeksI'd like to try the applesauce and/or apple butter with my first deliveryNo, thank you.
How many pint jars of applesauce would you like every four weeks ($5.00/jar)?
How many half-pint jars of apple butter would you like every four weeks ($6.00/jar)?
How many pint jars of applesauce would you like with your first delivery ($5.00/jar)?
How many half-pint jars of apple butter would you like with your first delivery ($6.00/jar)?
Your total cost of applesauce and apple butter ordered:

Contact Information
First Name*
Last Name*
Email address*
example@example.com
Phone Number*
Receive delivery reminders via text to this phone number?

YesNo
Secondary Person in This Household (Optional):
Secondary First Name
Secondary Last Name
Secondary Email (Optional)
example@example.com
Secondary Phone Number (Optional)
Please enter a valid phone number.
Receive delivery reminders via text to the secondary phone number?

YesNo
Street Address*
City*
State*
Zip Code*
Are you splitting your CSA membership with another household? (We'll ask for their contact information as well)

YesNo

First choose delivery frequency:

	Quantity
Khaki
Tan