Purchase Shares Shareholder Agreement For the purpose of facilitating access to groceries and other consumer goods by providing necessary capital funds for a proposed retail food store, and to acquire an ownership interest in the Cooperative, I hereby subscribe to purchase one or more shares (not less than one share nor more than ten shares) at a price of one hundred dollars ($100.00) per share. [There is a service fee of $3.28 (per share) when paying online.] If you prefer to mail a hard copy, you may download the form here.About YouName(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email(Required) Phone(Required)Are you a veteran? Yes No Gender Female Male Other Prefer Not to Answer If gender "Other", please add belowRace (for grant & loan purposes)How did you hear about Shared Harvest?Newsletter Sign up for our email newsletter.To complete the Newsletter signup, please respond to our email confirmation to complete the signup process.Share Purchase DetailsShared Harvest Shares at $100 each (1-10) Quantity(Required) Price: $100.00 Quantity Limit of ten shares allowed per shareholder.Online Purchase Surcharge Price: $0.00 There is a service fee of $3.28 (per share) when paying online.Total Purchase Price Consent(Required) I agree to the Shareholder Purchase Rules, and the use of electronic records and signatures.The ownership interest hereby subscribed for is intended to confer the right to purchase consumer goods at owner prices and to participate in the governance of the Cooperative in accordance with its bylaws to be approved at a meeting of owners. The shares to be acquired hereby will entitle the holder to no dividends or other monetary return on capital, will be non- transferable except to the Cooperative, will be redeemable with limitations set forth in the bylaws of the Cooperative, and will be subject to other terms and conditions in the bylaws of the Cooperative. The capital funds remitted under this agreement are intended to be used for initial capital and startup expenditures for the proposed store. All such capital funds are subject to the risks inherent in any start-up enterprise of this character and may result in the loss of part or all of such funds. Although the Cooperative is committed to minimizing this possibility such risk cannot be avoided.Signature(Required)I hereby represent that I understand such risks and am willing and able to assume them.Credit Card(Required) Cardholder Name Card Details
