Online Shareholder Enrollment Form Shareholder Enrollment Form 1Personal Information2Shareholder Purchase Options3Terms & Conditions / Payment Name* First Last Email* Date of Birth* MM slash DD slash YYYY Phone*Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Please choose one of the following Shareholder options:* Working Shareholder — Earn a 5% discount on your Co-op purchases by volunteering 2 hours each month at the Co-op or at one of our Commitment to Community partners (discount activates post-volunteer hours). Elder Shareholder — Choose this option if your ares 65+ years of age. Elder Shareholders receive a 5% discount on all purchases at the Co-op. They are not required to do volunteer hours to earn their discount. Food for All Shareholder — Choose this option if you receive 3 Squares VT, SSI, EBT, WIC, disability, or have a referral letter from a local agency. FFA Shareholders receive a 10% discount on all purchases at the Co-op and are not required to do volunteer hours to earn their discount. Shareholder — Choose this option if you want to be a Shareholder, but the choices listed above do not apply to you at this time. As a Shareholder, I would like to receive BFC e-newsletters that include recipes, classes, coupons, events, sales, and more.*You can make changes to your subscriptions at any time. Yes No Terms and Conditions*I agree that all of the information I have provided is accurate and that I agree to become one of 8,000+ community members that own the Brattleboro Food Co-op and will share all the benefits that come with ownership. I understand that I am purchasing a single share and that my Shareholder Card and is valid only for my own use as well as any dependent child under 18 years of age. I understand that I am making a one-time investment of $80 for my share, which will help promote the growth and sustainability of the Brattleboro Food Co-op, and that my investment dollars will stay within the community. I understand I am purchasing one share of the BFC, and I understand that share is fully refundable if I choose to withdraw it at any time. Whereas my share can be purchased in total upon my joining today, I may qualify to break up the entire amount into smaller payments (which can be made over/up to 4 years) depending on the Shareholder program I qualify for. I understand that as a Working Shareholderdiscounts are not active until my initial two hours of volunteer work have been completed, and are based on 2 hours per month thereafter. Food for All Shareholder and Elder Shareholder discounts are activated when you pick up your Shareholder packet at the Co-op (which will be ready for you 72 hours after your share purchase). I agree to the above statements.Signature*Please sign your name here. Penmanship is not important. Reset signature Signature locked. Reset to sign again Choose your payment option.Please choose a payment amount toward your share according to the share option you made above: • Choose to pay the full amount now ($80). • Choose to start an installment plan with as little as $20 toward a Basic, Working, or Elder share. • Choose to start an installment plan with as little as $5 toward a Food For All share.Co-op Share (Basic or Working Shareholder)*Enter your payment amount: Pay the full amount of $80 now, or pay $20 (or more) toward an installment plan (to be completed within 4 years). A minimum payment of $20 is required. Elder Shareholder (must be 65+ years of age)*Enter your payment amount: Pay the full amount of $80 now, or pay $20 (or more) toward an installment plan (to be completed within 4 years). A minimum payment of $20 is required. Food for All Shareholder*Enter your payment amount: Pay the full amount of $80 now, or pay $5(or more) toward an installment plan (to be completed within 4 years). A minimum payment of $5 is required. Credit Card*Card Details Cardholder Name EmailThis field is for validation purposes and should be left unchanged.
News Shareholder Spotlight: Andrew Courtney Shareholder Spotlight: Nancy Alexander Shareholder Spotlight: Marilyn Chiarello Shareholder Spotlight: Kirby Vietch Natural Egg Dye Cheese Madness Updates BOD Meeting Agenda: March 2023
