Application Form

Please, submit your application, give us a call, or email us anytime Monday through Saturday (closed Sundays).

FarmerJon@FirstWatchFarms.com
717-419-7611

Yes, I wish to join FirstWatch Farms!

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If this is your first year with FirstWatch Farms, how did you first hear about it?:
	Word of mouthFarm to City emailFarm to City websiteOther websitePoster/FlyerMagazine or newspaper articleMeeting announcementSustainable Business NetworkBuy Fresh Buy Local campaignRadioOther (please specify)
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Optional: tell us who your health insurance provider is to help us persuade local insurance companies to give discounts to CSA members.  Read more.
	AAAAABCOAcceptanceAccess InsuranceAcordiaAegis SecurityAetnaAffirmativeAIGAig Allied AmcoAll NationAll RiskAllianzAlliedAllstateAllstate IndemnityAmerica's Ins. ConsultantsAmerican AllianceAmerican BanksAmerican EconomyAmerican FamilyAmerican GeneralAmerican NationalAmerican PremierAmerican ReliableAmerican RepublicAmerican StandardAmerican StatesAmerisureAmicaAPIArbellaArizona GeneralAssigned RiskAssociation Field ServicesAtlanta CasualtyAtlanta SpecialtyAtlantic IndemnityAustin MutualAuto OwnersAvomarkBadger MutualBankers & ShippersBankers Life and CasualtyBlue CrossBlue Cross Blue ShieldBonnevilleBoston Old ColonyBuildersCalifornia CasualtyCamdenCapital ChoiceCare EntrieCascade National InsCasualty AssuranceCentennialCharter OakChicago InsuranceChubbChurch MutualCignaCitizensClarendonCloverleafCMACMA AllianceCNAColonialCombinedCommercial UnionCommonwealthContinentalContinental GeneralCottonwoodCountry InsuranceCredit UnionCriterionCUNA MutualDairylandDakota FireDeerbrookDepositors EmcascDixieEbco GeneralEconomyEconomy Fire & CasualtyEconomy PreferredEMCEmpireEmployers FireEnsureEquitable LifeErieFacilityFarm BureauFarm Bureau St. PauFarmersFarmlandFederalFederatedFederated AmericanFederated GroupFidelityFinancial IndemnityFiremans FundFirst AmericanFirst FinancialFirst GeneralFirst NationalFord Motor CreditForemostFortisFranklinGeicoGEICO CasualtyGeico IndemnityGeneral AccidentGeneral Accident GrGeneral CasualtyGeneral InsuranceGlobeGMACGolden RuleGovernment EmployeesGrangeGRE Harleysville HGreat AmericanGreat WayGreat WestGrinnell MutualGuaranty NationalGuardianGuidant CasualtyGuide OneHalcyonHanoverHappy DaysHartfordHawkeye SecurityHealth NetHeritageHorace MannHumanaIDSIGF Ins.InfinityInsur. of EvanstonIntegonInterstateJohn DeereJohn HancockKemperKentucky CentralLeader GeneralLeader NationalLeague GeneralLiberty MutualMarathonMarkel AmericanMaryland CasualtyMass MutualMega Life & HealthMendotaMendota MetropolitaMerastarMercuryMetropolitanMid CenturyMid-Continent CasualtyMid-West Ntl. LifeMidCentury (Farmers)Midwest MutualMillbankMillers MutualMilwaukeeMilwaukee GeneralMilwaukee GuardianMilwaukee MutualMinnehomaMissouri GeneralModern Woodmen of AmericaMony GroupMotorsMountain LaurelMSIMutual Of EnumclawMutual Of OmahaNASENat Assoc - Self EmployedNat'l Farmers UnionNational AllianceNational ColonialNational ContinentalNational IndemnityNational MeritNational Surety CorpNationwideNationwide MutualNew England FinancialNew York LifeNorth AmericanNorth PacificNorth PointeNorth ShoreNorthern CapitalNorthern StatesNorthlandNorthwest PacificNorthwesternNorthwestern MutualOhio CasualtyOhio SecurityOlympiaOmahaOmni Ins.Oregon MutualOrion Ins.PafcoPaloverdePatriot GeneralPemcoPenn AmericaPenn MutualPennsylvania NatlPhoenixPinnaclePioneer LifePreferred AbstainersPreferred RiskPreferred Risk MutuaPremierPrestigePrimericaPrincipal FinancialProgressiveProtective CasualtyProtective LifeProvidentPrudentialQualityRamseyRangerRegalRelianceReliantRepublic IndemnityRockford MutualRodney D. YoungSafecoSafeway Ins.Sea West InsuranceSecuraSecurity NationalSedgwick JamesSentryShelterSkandia TIG TitaSpectrumSt. Paul CompaniesStandard GuarantyState AutoState FarmState Farm Fire & CasualtyState MutualState National InsSun CoastSuperiorSutterThe HartfordTitan IndemnityTotalTowerTravelersTri-State ConsumerTrinity UniversalTrust HallTwentieth CenturyUGAUnicareUniguardUnionUnited AmericanUnited FinancialUnited Fire & CasualUnited Fire/CasualtyUnited SecurityUnited Services AutoUnited States FideliUnitrin Inc.UnsureUS Health AdvisorsUSAAUSF&GUtah Home and FireUticaVasa North AtlanticVigilantVikingWawaunesaWellingtonWest AmericanWest Bend MutualWest FieldWest PlainsWestern NationalWestern Southern LifeWestfieldWindsorWindstarWisconsin MutualWorkmans AutoWorldwideYellow KeyYosemite
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Be sure to record your password so you will have it when you order!.

Wayne CSA On Farm Pick-Up (Lititz, PA)

You will receive exact location of pick up after we receive your application.

Indicate the types and quantities of shares you would like to purchase for the current season:

Share	Description	Cost	Qty
Full Vegetable Share	As a CSA participant you will receive a weekly share of fresh, vine-ripened, seasonal vegetables for a 22-week period, beginning May 25th and ending October 19th. A Full-Share is designed for 2 adults and 2 children.	$530.00
Half Vegetable Share	As a CSA participant you will receive a weekly share of fresh, vine-ripened, seasonal vegetables for a 22-week period, beginning May 25th and ending October 19th. A half-share is designed for 2 adults.	$330.00
Fruit Share	Your fruit share will include 4 quarts of strawberries in June and 4 quarts of blueberries in July.	$40.00
Total:		$0.00

Payment CSA share total cost: $ 0.00 I will mail my check for: $ Check #: I wish to join to First Watch Farm for the 2010 season. I or someone I have designated will pick up my share on the delivery day of the location I have selected. If I fail to pick up my share by the end of the pickup time, my share will be disposed of at the site host's discretion. I understand that: a) the crops planted, the harvest schedule, and the amounts in each share will follow the approximent items/amounts shown on the home page; b) it is possible that some crops will partially or wholly fail due to adverse weather conditions or pests; c) First Watch Farm will try its best to replace lost crops with suitable substitutes; d) First Watch Farm will deliver the my share during the production period to the location I have selected; and e) if inclement weather or other factors prevent the scheduled delivery, First Watch Farm will inform me and schedule a make-up delivery.

Please make your check payable to "Jonathan Einwechter", and mail it directly to us. You will be considered a CSA member once we receive your check. Thank you again! Jonathan Einwechter FirstWatch Farms 584 Mumma Road Lititz, PA 17543-9403

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