Owner Withdrawal – Davis Food Co-op

Owner Withdrawal Form

We need your valid mailing address, phone number, email address and a form of identification. Must be signed by the Member-of-Record to be valid.
Must present valid ID with form. Only Member-of-Record may Withdraw.

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 upload 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