Ownership Application

Submit the form below to become an owner of the Placerville Food Co-op. Please allow 3 business days for your application to be processed.

Name on Account*
Primary Member - Required
First Last
Optional Second Name
Example: Spouse, Partner, Household Member
First Last
Email*

To be used with co-op communication only. will not be shared.
Phone*
Best number to reach you at during daytime hours.
Phone 2
Optional Second phone
Address*
Street Address City State ZIP Code
How did you hear about the Co-Op?
How would you like to pay?*
You may choose to pay your full $300 investment up-front or begin a payment plan: $25 now and $25 quarterly until $300 is reached. *To receive owner discounts & benefits must be current without past due payments.
Official Member Newsletter
- Yes, add me to the member's newsletter subscription list.
New Owner Announcement Consent
We would like to announce new owners in our monthly email newsletter.
- I consent to being announced as a new owner in the Co-op's email newsletter.
- I DO NOT consent to being announced as a new owner.
*
- By submitting this form, I accept the terms and conditions of ownership.