Membership Application

Name of Primary Member

First Name *

Last Name *

Phone *

Email *

Street Address *

City *

State *

Postal code *

Name of Extra Authorized Adult Household Member

Names of Dependents

Owner Share Capital Investment

Select a payment option *

$240 one-time payment

$40 monthly installments

$10 monthly installments

$2 monthly installments

Pay in full with a one-time payment, or invest over time until reaching a $240 equity share investment.

Ownership Agreement *

By submitting this Membership Application, I certify that I have read and agree to all the language in the Co-op Ownership Agreement. (View the agreement at https://orcasfood.coop/ownership-agreement/).

Collect Payment *

$ 240

$ 40

$ 10

$ 2

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