Shareholder Membership Application

SHAREHOLDER MEMBERSHIP APPLICATION

$315/MONTH BASE RATE
Name*

First NameLast Name
Email*
example@example.com
Date of Birth*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
SPOUSE INFORMATION

$63.00/MONTH
Spouse Name

First NameLast Name
Spouse Email
example@example.com
DEPENDANTS

$20/MONTH ($40 Max)
Dependant 1

First NameLast Name
Dependant 2

First NameLast Name
Dependant 3

First NameLast Name
An application fee ($50), last months deposit ($315+tax), and a capital share fee ($350) will be due once your membership is approved.

Dues are billed at the end of each month.
Signature*

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SHAREHOLDER MEMBERSHIP APPLICATION