Online Shareholder Enrollment Form |

Shareholder Enrollment Form

1Personal Information

2Shareholder Purchase Options

3Terms & Conditions / Payment

Name*
First Last
Email*
Date of Birth*
MM slash DD slash YYYY
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Authorized Users
You may add up to TWO adult authorized users, that live within your household. Please add them by First and Last Name, separated by a comma in the field below.

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.
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
Phone
This field is for validation purposes and should be left unchanged.

Online Shareholder Enrollment Form

Shareholder Enrollment Form

Choose your payment option.

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