Account Information

1. What is Your First Name?
   First Name:
2. What is Your Last Name?
   Last Name:
3. What is Your Email Address?

   You need an email address to use our system.

   Email Address:
4. What is Your Phone Number?

   Please enter a number where we can reach you on pick-up days. If it gets close to time to pack up and you haven't picked up your order (everyone forgets at least once!), we'll give you a call at this number.

   Phone Number:
5. What is Your Mailing Address?

   We may not use this for anything, but if we ever print up newsletters, postcards, or anything like that, it'd be nice to know how to send you one.

   Address (Line One):
   Address (Line Two):
   City:
   State/Province:
   ZIP/Postal Code:
6. Where will you usually be picking up your orders?

   This market has several pickup locations, listed below. Choose the one that you will go to most often. You'll be able to change this on an order-by-order basis, but what you choose here will be your default (you can always change it again later). For a more detailed list of locations look at this page.

   Default Location: Please choose a location Creative Healing Jarvis Health Clinic Valley Animal Hospital
7. Create an Account Name

   You'll use this name to log into your account.

   Account Name:
8. Assign Yourself a Password

   It must be at least five characters long.

   Password:
9. Finally, Confirm Your Password

   It must match what you just typed above.

   Password (Again):