Name *

First Name

Last Name

Phone *

(###)

###

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How much milk are you interested per week? *

2 gallons = $38 (bulk discount)

1.5 Gallons = $30

1 gallon = $20

1/2 Gallon = $10

How often do you want to get milk?

Once a week

Every other week

Twice a week (split my order into two days)

Best day of the week for milk pick up *

Check all that apply. We may only have one or two days open in the milkshare so your pick-up options are limited by how much milk Ursula produces a day and who else is getting milk.

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Milkshare membership costs *

ONE TIME MILKSHARE MEMBERSHIP FEE ½ Share = rights to ½ gallon every week = $10 one-time membership fee 1 Share = rights to 1 gallon every week = $20 one-time membership fee 1.5 Share = rights to 1.5 gallons every week = $30 one-time membership fee 2 Shares = rights to 2 gallons every week = $40 one-time membership fee After purchasing your MILKSHARE membership, you can get that amount of milk each week. If you bought a ½ share, you have access to ½ gallon of milk each week which will be $10 per jar paid at the beginning of the month.

I understand there's a one-time membership fee.

Are you currently buying raw milk somewhere? *

Yes

No