Membership Application Business Hensall Co-op

Membership Application - Business

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

Direct Deposit: Forward copy of a void cheque or a completed direct deposit form from your banking institution via fax 519-262-2317, mail to Hensall Co-op or deliver to a Hensall Co-op location, Attention: Membership.

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

Business Information
* Legal Business Name
* Type of Business	Sole Proprietorship Partnership Corporation
* Name Designated voting representative
* Date of Birth Designated Voting Representative's date of birth is required.
Second name The name of the second principle within the company.
Mailing Address
Street Number or 911 Number
Street Name
Post Office Box #
RR #
* City/Town/Village
* Province
* Postal Code
Business Details
* Phone Number The phone number we can reach you during business hours.
* Corporate Tax Number Business Number
Email address
Description of Business/Industry
Size of Operation: Acres Owned
Size of Operation: Acres Rented
Farm Type	Cash Crop Livestock IP/Dry Beans Not applicable Other
Products & Services Requested	Animal Nutrition Beans Grain Crop Protection Products Energy Investments
Additional Information
* How did you learn about Hensall Co-op?	Referral or word of mouth Our website Social media Newspaper or trade publication Other
If you selected newspaper/trade publication/other in the above question, please provide the name(s) here.
* How would you like to receive membership information?	Email Phone None
* How would you like to receive the Annual Report?	Email I don't need the Annual Report sent to me.
* How would you like to receive our members' newsletter "What's Growing"?	Email I will pick up a copy at my local Hensall Co-op Not interested
* Would you like to receive our marketing/promotional information by email?	Yes No
* Membership Fee - $100 The membership fee is a one-time fee.	Charge my account Payment will be mailed On-line bill payment through my bank
* 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