New Customer Sign-up Form

Simply print this page and fax it to Farm Fresh Organics.

Calgary Area Fax (403) 210-3720Edmonton phone 1 800 563-1517

First Name:
Last Name:
Apt #: ________ Street
City:
Province: Postal Code:
Email:
Residential Phone: ( ___ ) ____________
Business Phone: ( ___ ) ___________ Extension: ________
Fax Number:
( ____ ) _________		 Cover Sheet Required?
Yes ___ No ___

Box Choice
(Please Select Type and Delivery Schedule)

Family Fare Bin: Cycle: Biweekly Weekly
Fruit Basket: Cycle: Biweekly Weekly
Salad Bowl: Cycle: Biweekly Weekly
* Delivery of one-time order is $55 minimum plus delivery charge
I have 1 or 2 bin(s) from another delivery company that I can use as trade-in.**
**Each bin that you have can act as a $10 credit toward your $20 bin deposit.

Prepayment Option
(save 5% when paying for 13 bins in advance):

Family Fare Bin:
Fruit Basket:
Salad Bowl:

Type of Payment:

Visa Master Card
Cheque payment option not available
Credit Card Number # ____________________ Expiration Date:____/____ (month/yr)
Name exactly as it appears on the card:
I authorize this card to be used to pay for deliveries as required
Date Start Delivery:
____/____/____ (month/day/yr)		 Date Bin Deposit Paid:
_____/_____/_____ (month/day/yr)
Best Delivery Time: AM PM
Special Delivery Instructions:

Delivery Service Agreement

Your Preferences
The contents of your box changes weekly. A list of box contents, grocery prices and specials are sent out each week in our newsletter. All this information is also available on our website, which is updated each week. Sometimes we can't get items that are supposed to be in your box due to poor quality, short supply, huge price increases, etc. Please answer the following in order that we can build your box to the best of our ability.
Items I would never like in my box:
My top three vegetable choices are:
My top three fruit choices are:
Please leave my box: