Cleaners Coop Membership Application

Co-operative Cleaners of Ontario Inc.

Membership Application
I hereby submit my application for membership to the Co-operative Cleaners of Ontario Inc., and agree to conform to the by-laws of the Co-operative, the Act, Policies and Rules.

Membership Shares: Cost is $100 per share. A member must not exceed more than 10 share per year, per member. The total amount of shares held by any member does not exceed $10,000. No transfer of membership share is allowed.
Number of Shares*

12345678910Other
(PREFERENCE SHARES AVAILABLE TO INTERESTED INVESTORS)
Name*

First NameLast Name
Title*

MrMsMrsMissOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth:*

MonthDayYear
Date
Citizenship:
Email Address:*
example@example.com
Home Telephone:*
Cell:*
How did you learn about our Co-operative?
Please supply 2 forms of ID*

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I hereby certify that the statements and information on this application form are true and correct to the best of my knowledge and belief and I authorize the Co-operative Cleaners of Ontario Inc. (CCOO) to investigate all statements or other information contained in this application form
Member's Signature:

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Date:

MonthDayYear
Date
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