315 5th Ave. S. New Member « Household
La Crosse, WI 54601
608-784-5798 Stock Receipt « Organization
Welcome to the Co-op! The cost to join is $100 for the primary member for 1 A (voting) and 3
B (investment) shares at $25 each. The primary member may include up to 2 additional members
(other people in the household or business) by purchasing a B share for each. Only the primary
member may add or delete people from the membership, terminate the membership, or receive refund
checks. All members may receive member discounts, run for the board, and sign ballots. Please read
your member policies and bylaws for more membership information.
MEMBER #1 ($25)
MEMBER #2 ($25)
Add $7 to total if choosing to pay on installment plan
(see Payment Options below)
ORGANIZATION NAME (if joining as business or organization) FEDERAL TAX NO. (required for bus. or org.)
OR PO BOX
CITY STATE ZIP
« Pay in full
« Installment Plan—Pay for 1 A share ($25) plus a $7 nonrefundable administrative fee (total
of $32 due now); we will bill you $25 per quarter until your share purchase is complete.
« Special Circumstances membership—Pay for 1 A share ($25); B share payments are waived;
requires an approved Special Circumstances form and annual renewal.
I understand that my membership is subject to the bylaws of the People’s Food Cooperative.
Primary Member ________________________________________________________________
Method of payment: « Cash « Check # ________ « Credit Card « Gift Cert. # ________
Name _________________________________________________ Date ____________________
WHITE – Membership basket YELLOW – Cashier’s Drawer PINK – Member