Enrollment Form

enrollment form

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone *

Email *

Please select Harvest Cash Card Level *

$115 Level (+$10 Bonus Cash) $215 Level (+$25 Bonus Cash) $320 Level (+$45 Bonus Cash)

Please select your preferred payment *

credit/debit card check UMass 5 College Credit Union Farm Share Loan

If paying by credit or debit card, please provide credentials below.

If you do not feel comfortable providing your credit or debit card information on this form, please call (413) 800-5583 or message [email protected] to complete the transaction
all information is private and will not be shared
credit card information will be destroyed after credit card transaction is complete

Credit or Debit Card Number *

Expiration Date *

Security Code *

If paying by check please make it out to Bardwell Farm and remit to Bardwell Farm, 49 Main St, Hatfield MA 01038
Your Harvest Cash Card will only become valid when we receive the enrollment form and payment
For the UMass Five College Credit Union Farm Share Loan please click here for information
Note: Massachusetts sales tax will be charged due to the way this program is presented

The Harvest Cash Card programs runs from June 2nd to October 31st
The Harvest Cash Card covers fruit and vegetables only
I have to have my Harvest Cash Card with me to make a purchase
If I lose my card, there will be a fee of $25 to reload another
I am fully aware I have to use my funds on my Harvest Cash Card by October 31st or I will lose them and the card becomes null and void

Agree to these terms by typing your name below *

Submit Form

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