Installment Ownership Application

Primary Shareholder's Information

First Name

Last Name

Phone

Birthdate

Mailing Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

List the names of additional household members who will be using this owner number, if applicable:

Acknowledgement

I am applying to purchase one (1) Ownership Share in Deep Roots Market, Inc., under the policies and conditions stated in the Co-operative's Articles of Incorporation and Bylaws.

Check to agree to the above terms

I agree

Signature

To accept this contract, type your name below

Payment Information

Billing Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

County

Select

Zip Code

Sub Total

$25.00

Processing Fee

$1.25

TOTAL

$26.25

Payment Method

Credit or Debit Card

Credit Card Type

Select

Name on Card

Credit Card Number

Expiration Date

Month

Year

Verification Number

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Welcome to the Co-op!

Thank you for making an investment in your community and becoming an Owner of Deep Roots Market Co-operative!

Please allow up to three days for us to process your Ownership Application and get everything squared away. We'll send you an email or give you a call when your New Owner Packet is ready to pick up at the store.

We look forward to sharing the benefits of ownership with you!

View Submission