Membership Application

Fill out the Owner Membership Application below.

After you submit your information, please make your payment.

Date*

Full Name* (one person/purchase only)

Street Address*

City*

State*

Zip*

Phone*

Email*

Payment Amount / Number of $20 Patron Membership Interests you are purchasing*
(Note: 5 Patron Membership Interests / $100 Payment Amount required to become a fully vested Owner)

How will you pay?*
(Note: For PayPal, there will be a convenience charge of $1 per Interest paid in order to cover PayPal fees)

I hereby apply to be an Owner Member of Daily Groceries Co-op and subscribe for and intend to purchase at least one Owner Membership Interest for each year that I am an Owner Member. I understand this application is subject to approval by the Board of Directions, my membership is subject to the articles and bylaws of this association, Membership Interests can be transferred or sold back to the Cooperative only upon approval by the Board of Directors, and that Daily Groceries Cooperative is organized under Title 11 of the Vermont Statues, Chapter 7.

Please type your name to represent your signature