Owner Withdrawal – Davis Food Co-op

Owner Number *

Member-of-Record First Name *

Member-of-Record Last Name *

Mailing Address *

City *

State *

Zip *

Email *

Phone *

I hereby withdraw from ownership in the Davis Food Co-op, Inc. I ask that:

Reason for Withdrawal (mark all that apply)

Moving

Shop elsewhere

Insufficient Owner Benefits

OtherOther

Upload a photo of your ID here

Maximum file size: 268.44MB

Enter Member-of-Record Name and Date here as an electronic signature

First

Last

Date

Enter Co-Owner Name and Date here as an electronic signature (if applicable)

First

Last

Date