New Roots Fresh Stop Shareholder Interest Form

 

 

This is a grassroots effort and shares of farm fresh fruits and vegetables will be offered for $25, $12 for anyone low income or $6 for those receiving WIC. We will also be able to accept SNAP.The information on this form is simply to get statistical data for our Fresh Stop. All information will be confidential. If you are interested please complete the form online. For further questions please contact New Roots, Inc at 502.609.6770.

 

What type of health insurance do you have? (choose all that apply) *
Why are you interested in participating in Fresh Stops (check all that apply) *
 
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