The Farmer's Market to Your Door

Save Time & Money . . . Support Local Farms . . . Eat Fresh

     
 
 

Create New Customer Profile

 
 

The form below allows you to create a profile which is necessary to place orders. Do not forget that this information is essential to use our services correctly.


Personal information
First Name *
Last Name *
Company  
Who referred you?  
Gift Recipient Name  
Billing Address
Address *
Address (line 2)  
City *
State *
zip code *
Pickup Location
Location *
Delivery Address (leave empty if same as billing address)
Address  
Address (line 2)  
City  
State  
zip code  
Please check if this is a business address  
Pick Your Delivery Day  
Contact Information
Phone *
E-Mail *
Confirm email *
Additional E-mail  
Additional Phone  
Additional information
How would you like your FarmBox packaged? (ONLY eco-baskets come with reusable ice) *
How did you hear about us?  
Plastic or reusable mesh produce bags? ($.50 deposit per reusable mesh produce bag) *
Special instructions to your home and/or access to apartment building?  
Where to leave your FarmBox if you're not home?  
Gift card message:  
Shipping outside Los Angeles. $1-$19.95: $7.95 S&H $19.95-$49.95: $9.95 S&H $50+: $12.95 S&H  
Payment information
Payment method   Credit card
Credit card number (no spaces or dashes) * You have not entered your payment details yet...
 
Discount coupon
Coupon code  
Username & Password
Username *
Password *
Confirm Password *
Miscellaneous options
Produce dislikes  
   
   


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