Brookfield Farm 2010-2011: Winter Share Purchase Form

Share Price: $130

Standard Share Payment Plan:
$30 deposit before Sept 20, 2010 to "Save Your Share"
$100 balance payment by November 19, 2010

If you need a special payment plan, please let us know

Payment Options (check one):
___Check: Make checks payable to Brookfield Farm and send to address below.
___Online Payment: click on paypal link on the previous webpage - www.brookfieldfarm.org/WinterShare.html
___Food Stamps: Send back this form, include no money, and we'll contact you with details.

I want ___Winter Share(s): $____

Amount enclosed $____

Signature_______________________

Please fill out the information below to keep our records up to date:

Name(s) _____________________________________________________
Address(es)___________________________________________________
Phone______________________________
Email________________________________________________________

I have a regular share at Brookfield Farm___Next Barn Over____Other___(Circle One)

Make checks payable to Brookfield Farm and send to:

Brookfield Farm, P.O. Box 227,  Amherst, MA 01004