Payment for Member-Owner Application

Complete this payment form to apply online to be a member-owner of the Wasatch Cooperative Market.

The base ownership amount is $300.00 + $10.00 for online processing fees.

First Name *

Last Name *

Organization

Address *

Address2

City *

State *

Zip *

Phone *

Email *

How did you hear about Wasatch Cooperative Market?

I would like to offer my support as a:

Volunteer	Committee Member	Advisor
Other (put in comments)

Comment

Please list helpful skills or other information

By checking this box, you acknowledge that you have read the Member-Owner Disclosure, and that you understand the information contained therein