Membership Application Business Hensall Co-op

Membership Application - Business

If you have any questions please call 1.800.265.5190, option 2.

Disclaimer: By completing this application you authorize and consent that Hensall District Co-Operative, Incorporated can release your information when required by the Co-Operative Corporations Act (section 120).

If you prefer - we have a pdf form that can be completed and returned to us:

Business Membership Application Direct Deposit Form

Business Information
* Legal Business Name
* Type of Business	Sole Proprietorship Partnership Corporation
* Name Designated voting representative
Position/Title
* Full Mailing Address (include 911 municipal address, Town/City, Province and Postal Code)
* Email address
* Primary Phone The number you can be contacted at during regular business hours.
Mobile Phone (if different from Primary)
* Date of Birth (DD/MMM/YYYY) Designated Voting Representative's date of birth is required.
Co-Applicant
Name of Co-Applicant If applicable
Phone Number of co-applicant
Co-Applicant’s Email Address
Position/Title of Co-applicant
Business Details
* Corporate Tax Number Business Number
Description of Business/Industry
Farm Type	Cash Crop Livestock (Swine) Livestock (Poultry) Livestock (Dairy) IP/Dry Beans Other Not applicable
Products & Services Requested	Grain Marketing Energy (Fuel/Propane) Crop Input Products (Fertilizer, Seed, Ag Chemicals) Food Grade Soybeans Edible Dry Beans Animal Nutrition Investments
Size of Operation: Acres Owned
Size of Operation: Acres Rented
Do you have any on farm storage	Yes No
If yes, how much?
Additional Information
Closest Hensall Co-op location
Do you currently do business with Hensall Co-op	Yes No
Current Hensall Co-op contact
What business divisions would you like to learn more about	Grain Marketing Energy (Fuel/Propane) IP/Dry Beans Crop Input Products (Fertilizer, Seed, Ag Chemicals) Animal Nutrition
How did you hear about Hensall Co-op	Social Media Friend/Family Ontario Farmer Other
* I agree to receive Hensall Co-op emails about Ag Alerts, Product Updates, Promotions and Member Newsletters	Yes No
For Sole Proprietorship/Partnership/Charity Applications One of the following must be submitted: Partnership Agreement, Partnership Registration, Articles of Association, Articles of Incorporation, Articles of Amalgamation, Certification of corporate status, Charity or Not-For-Profit Charter documents, Charity or Not-For-Profit Bylaws, Charity or Not-For-Profit meeting minutes signed by the Entity’s Secretary, Confirmation of an Association’s Directors issued on Association’s letterhead or Letter from a parent governing body confirming authorization for Association to operate. I/we agree to forward a copy via one of the following methods: 1) email to [email protected]; 2) fax at 519-262-2317; 3) mail to Hensall Co-op at 1 Davidson Drive Hensall ON N0M 1X0; or 4) deliver to a Hensall Co-op location, Attention: Membership. Agree
For Corporations One of the following must be submitted: Articles of Incorporation, Articles of Amalgamation or Certificate of Corporate Status. I/we agree to forward a copy of the required document via one of the following methods: 1) email to [email protected]; 2) fax at 519-262-2317; 3) mail to Hensall Co-op at 1 Davidson Drive Hensall ON N0M 1X0; or 4) deliver to a Hensall Co-op location, Attention: Membership. Agree
* A void cheque AND direct deposit form must be submitted. I/we agree to forward a copy of these via one of the following: 1) email to [email protected]; 2) fax at 519-262-2317: 3) mail to Hensall Co-op at 1 Davidson Drive Hensall ON N0M 1X0; or 4) deliver to a Hensall Co-op location, Attention: Membership. The Direct Deposit form link is provided at the top of this page. Please complete, sign electronically, save and return to us. Agree
* Membership Fee - $100 The membership fee is a one-time fee.	Payment will be mailed On-line bill payment through my bank Credit Card (2.40% Surcharge)
* Apply for membership By selecting "Agree" and submitting this form, you: are signing this application electronically, agree your electronic signature is the legal equivalent of your manual signature, and agree to the terms and conditions stated.	Agree