Owner Application – SunCoast Market Co-op

Ownership type (Household or Business)^*

Business Name (if applicable)

Owner Information

First Name^*

Last Name^*

Address

Address Line 1

City

State or Region

Zip

Phone Number^*

Email^*

I authorize the following individuals from my household/organization to shop on my owner card: (must be in your household and authorized individuals do not have voting rights)

If you were gifted this ownership, please state who gave it to you:

You have an option to pay for someone's ownership. In order to track it, we need the gift givers name.

Payment Information

Payment Type Choice

If you choose check or cash or a payment plan, you will be directed to a payment information page after submission and will receive an email with instructions for how to pay.

Please select your option (leave blank if it was a gift):

Full Payment Now (cover our processing fee) ($ 207)
Full Payment Now (without processing fee-cash or checks) ($ 200)
Payment Plan (20 payments, including processing fee) ($ 10.85)

For each $200 share electronic payment, we pay a $7 processing fee. You can choose to pay this fee, or opt out. Our $10 a month plan will include a $17 service fee.

Payment plan is $10.85 a month as it will include a service fee. There will be 20 payments. There are no refunds.

You may choose to purchase additional shares to support the store financially. You will not receive additional votes or dividends/returns. Max 8 additional shares allowed.

This is an optional choice. You may choose to purchase additional shares to support the store financially. You will not receive additional votes or dividends/returns. Max of 8 extra shares allowed.

Owner Agreements

Here is the Cooperative Ownership Disclosure (https://drive.google.com/open?id=0B7n5UDm55H1Pa2NHaDNtb3Uxcm8). Please check the boxes below:^*

I agree to receive ballot materials and official correspondence by email
I acknowledge receipt of a copy of the Cooperative’s Ownership Disclosure

Ownership Terms^*

I hereby apply for ownership status in the SunCoast Co-Op Market
I understand that additional persons (listed above) in my household may use my Co-Op account and do not have voting rights
I certify I am 18 years of age or older

By typing your name below you are submitting an electronic signature indicating your agreement to become a SunCoast Co-op Market owner. If you would like to submit a written, signed copy, please email us for a printable application.^*

Other Helpful Information

All owners can receive a free yard sign to help promote the store. Would you like a yard sign?

Yes
No
I would like a sign for my business instead

Can we announce that you are an owner in our marketing materials and/or website? This will be one part of our promotion campaign.^*

If you heard about us from another owner, please share their name so we can thank them!

Would you like to volunteer?

Yes
No
Possibly

We have options from simple to committed!

Check Out

You can pay in full with: --PayPal --Credit or Debit Cards (select Stripe or Paypal) --Cash (select Offline) --Check (select Offline) If using our Payment Plan, select Offline OR --If it was a gift, select Offline *For Offline payments, you will be directed to a detailed payment information page after you submit your application. If it was a gift, no further action is required after submission.

Select a payment method^*

Pay Offline