Membership Application Business Hensall Co-op

Membership Application - Business

If you have any questions please call 1.800.947.8816, 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.
* Address Full mailing address, including 911 municipal address, RR#, town/city, province and postal code.
* 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 - $50 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