Membership Application

Your Name *

First Name Last Name

Your E-mail *

Your Address *

Address
Street Address Line 2
Town	County
Postcode	Country

Phone Number *

Area Code Phone Number

Choose the size of your veg share *

Small: £9 per week = £39 payable monthly Medium: £13.50 per week = £ 58.50 payable monthly Large: £20.25 per week =£87.75 payable monthly

We also offer a fortnightly veg share at half the monthly cost

Yes please. I'd like my veg every other week.

Please choose your collection hub *

Wivenhoe - Station Pub car park, West St. (Tuesday from 5pm) Brightlingsea - Victoria Place (Friday from 5pm) Lawford - Peach and Pippin, Hungerdown Lane. (Friday from 5pm) Colchester - Church Walk, off Head St. (Friday from 5pm)

How many adults and children are there in your household.

This information will help us to plan social events that may appeal to your family

How did you hear about us? *

Social Media Leaflet Internet search Word of Mouth Local Event Poster

I am happy with the terms below. Please read and tick all boxes (see 'Terms and conditions' below for more details) *

I will give a minimum of 2 payment months notice should I wish to cancel my share.

*

I cannot take a payment holiday. If I go away I will notify the farm or arrange for someone to collect my share.

Any other comments