Borski Farms

251 West 100 South

Kaysville, UT  84037

(801) 941-9620

www.borskifarms.org, borskifarms@earthlink.net

Community Supported Agriculture RESTAURANT SHARE Registration Form, 2012

(Please print clearly)

Restaurant Name: ______________________________________________________

Name of Contact Person: _______________________________________________

Address: _____________________________________________________________

City: _________________________  State: ____________ Zip: ______________

Phone Number: ______________________ Email: ___________________________

I would like ____ (number) shares x $2,000.00 = ________________ (Total Enclosed)

Check one:

Delivery (for Salt Lake restaurants north of 2100 South) _____

                Farm Pick Up _____

Delivery Day (check one):

Tuesday ____

Thursday ____