Owner Equity Refund Form

Ownership Equity Refund Form

If you wish to request a refund of the equity you have invested in the Co-op, please fill out this form. The equity refund check will be mailed to you at the address you provide in this form (*not* the address in your owner account!), so please make sure to use an address you will get mail at. The Equity Refund may take up to three weeks. Thank you for being an owner in the Co-op, and we'll miss you!
Owner Name*

First NameLast Name
Owner Number*
Can't remember? Enter: UNSURE
Mailing Address (where you want your refund check mailed to!)*

Street Address

Apt/Unit/Suite

CityState

Postal Zip Code
I hereby request a refund of my accumulated ownership investment in accordance with the bylaws of the Ocean Beach People's Natural Foods Co-op. I understand that should I wish to re-join the Co-op within one year from the date of this withdrawal, I am required to re-invest the full amount of accumulated ownership investment withdrawn.*

Clear
Signature
Please check the reason(s) for withdrawal:*

I have moved/am moving from the area.The Co-op is too far from my home.I am dissatisfied with the Co-op (please, comment further below to help us better serve our owners in the future!)
Comments:
Administration Use Only

SB Amount: ____________ MB: Initials _____ Date ________

Check # _______________ Acct: Initials _____ Date ________
Are you a human?*
Should be Empty:

Ownership Equity Refund Form