Membership Application

First Name:

Last Name:

E-mail:

Phone:

Address:

By clicking submit

City:

State:

Zip code:

Choose Payment Plan

one installment of $100$105.00

4 quarterly installments of $27.50$28.50

student $25 per semester up to $100$26.00

income assisted - $25$26.00

Membership Agreement

I hereby apply for membership in the Locals’ Food Market Inc. With my $100 refundable investment, I am becoming part owner of this cooperatively owned grocery store. Member equity is used for development of this cooperative. By submitting this application, I agree to adhere to the rights and responsibilities of my self selected membership type and accept the terms of this Membership Agreement.

I agree to the above

You will be directed to Paypal to complete payment. All amounts include an online payment recovery fee at checkout.