Member Application

Thank you for your interest in becoming a member-owner at Mississippi Market Co-op. Please allow up to 5 days for processing your application. If you would like to become a member-owner and shop immediately, please join us in person at one of our stores, as we require time to process online applications.

To become a member-owner, fill out the membership application below and choose to pay a one-time stock investment of $90 or spread out the investment in a 2-year payment plan. Alternatively, you can learn more to see if you qualify for our affordable $12 LIME membership.

Membership Type(Required)

Mississippi Market Member-Owner

Mississippi Market LIME Member-Owner

Name (Primary account holder)(Required)

First Last

Would you like to add a household user?(Required)

Select an optionYesNo

Additional Household Member(Required)

First Last

Mailing 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)

Enter Email Confirm Email

Phone(Required)

Which store would you like to pick up your member-owner packet?(Required)

Select an optionSelbyWest 7thEast 7th

Did anyone refer you to join the co-op? If so, please let us know who:

Did a specific staff person refer you to join when you were in store? Let us know their name here

Would you like e-receipts?(Required)

Yes, please!

No, thanks.

Newsletter

Add me to e-newsletter mailing list

Membership Stock Purchase Agreement(Required)

I hereby subscribe for and agree to purchase 1 share of Class A stock and 14 shares of Class B stock in Mississippi Market Cooperative, Inc., at $6.00 per share. I also apply for membership in Mississippi Market. I understand that this membership application is subject to the approval of the Board of Directors, and that my membership is subject to the Articles of Incorporation and Bylaws of the Cooperative. I agree to abide by this Agreement, and to keep Mississippi Market notified of my current address.

You will receive a copy of Mississippi Market’s Articles of Incorporation and Bylaws and a copy of this agreement when you pick up your membership packet in store.

Signature(Required)

Date

MM slash DD slash YYYY

Payment Options(Required)

$90 payment in full

$25 down installment *

* $25 down installment paid today, followed by three $25 payments, one every six months for 18 months, totaling $100 (total includes a non-refundable $10 admin fee)

Payment Options(Required)

$12 LIME down payment, with future payments applied from patronage dividend earnings until $90 is reached*

* No payment due at this time. LIME membership payment and verification will be finalized in-store. LIME membership requires photo ID with same name as enrollment proof for: SNAP, Section 8, WIC, supplemental security income, social security disability, refugee assistance, general assistance. Must renew each year.

Total

Billing 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

Credit Card(Required)

Card Details

Cardholder Name

Untitled

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