Membership Equity Refund Request Form

Please note: Mississippi Market’s bylaws only allow equity refunds once membership is paid in full. If using the payment plan option, please complete all payments of $25 before requesting an equity refund. LIME memberships must have full $90 equity paid before requesting a refund. If requesting a refund in the event of a member-owner’s death, the executor of the estate or beneficiary may complete this form. This request will be presented at the next Board of Directors Meeting for approval. Depending on their meeting schedule, it can take up to 7 weeks to receive your refund.

Membership Type(Required)

Mississippi Market Member-Owner

Mississippi Market LIME Member-Owner

Stockholder's Name(Required)

First Last

Member-Owner Number(Required)

If you do not have your member-owner number, please call us at 651-310-9499 and we can look it up for you.

Mailing Address (Your equity refund check will be mailed here)(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

Reason for Leaving(Required)

Signature(Required)

Date

Phone

This field is for validation purposes and should be left unchanged.