Food for All

The Lighthouse | Black Girl Projects CSA Program

First name

Last name

Multi-line address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Phone

Communication Preference

Call

Text

Employment Status

Household Status

Secondary Contact Name: (The person you would like to pick up your share if you're unavailable)

Secondary Contact Email:

Secondary Contact Phone:

CSA Share Size and Pricing

Please select which large, medium or small share option you would like to sign up for:

CSA LARGE SHARE: 10-12 items (Ideal for large families and plant-based folks who like to cook or eat raw veggies five times a week)

Large Share Employee Deduction $45 (per week)

Large Share Direct Pay $45 (per week)

Large Share Full Pay $450 (10 weeks)

CSA MEDIUM SHARE: 7-9 items (Ideal for large families and plant-based folks who like to cook or eat raw veggies five times a week)

Medium Share Employee Deduction $35 (per week)

Medium Direct Pay $35 (per week)

Medium Share Full Pay $350 (10 weeks)

CSA SMALL SHARE: 5-6 items (The small share is perfect for an individual, a small family, or a household that cooks at home a few times a week)

Small Share Employee Deduction $25 (per week)

Small Share Direct Pay $25 (per week)

Small Share Full Pay $250 (10 Weeks)

SUPPORT SHARE FUND

PAYMENT METHODS

ELECTRONIC PAYMENT OPTIONS: If you have a payment app you would prefer us to use, please indicate which one.

Venmo

Zelle

Paypal

Enter your payment app handle or email

OTHER PAYMENT METHODS:

Cash

Check

Money Order

FINAL QUESTIONS

Do you have any food allergies or restrictions? Please list them here:

Is there anything else you would like for us to know?

Do you need any further financial assistance?

Yes

If "yes" please click here.