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Member-Owner Application and Agreement:
Harvest Co-op Markets
(see Membership Information)

Harvest Co-op LogoPlease fill in the following information and then click "send". You will receive your membership card in xx days. In the meantime, a temporary membership number will be sent to you by email on the next business day. You may use this temporary number when making purchases at our stores, or for any other member-related issues, such as voting for the Board of Directors.

You may list a second shopper (member of your household), but the membership will be in your name. (This is necessary for legal issues, such as equity, refunds, and voting).
I am signing up for:
(Choose the type of Membership you would like to purchase).

Equity Membership, fully vested ($200; equity account)

Equity Membership, annual investment (minimum $25/year in equity account)

Annual Membership: $25.00/year minimum, no equity account buildup

My total payment is:

$25.00

$200.00

other amount (whole dollars only)

Member Last Name (primary shopper):

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Member First Name (primary shopper):

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(if applicable:) Second Shopper Last Name:

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(if applicable:) Second Shopper First Name:

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Street Address or Post Box Number:

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City:

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State:

" />        Zip Code:    " />

Primary Phone:

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Work Phone: (optional)

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email address:

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I agree to notify the Co-op of any name, address or phone number changes:

I agree
Payment Information: If paying by check, credit card information is not required.
I will be paying by check:
*Credit Card Type:
*Card Number: " />
*Expiration Date:
*Security Code: " /> The 3- or 4-digit number on the signature strip on the back of your card
*Name On Card: " />
          

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