Ownership Resignation Form | Wheatsville Co-op

Please select one: *

Refund my capital investment. Please enter the address you'd like the refund check mailed to below.
Donate my capital investment to Wheatsville’s current Community Action group.
Donate my capital investment to Wheatsville.

Owner #

Please enter if you have your card handy. We can look it up if you don't.

Name *

Address *

City *

State

ZIP *

Phone

Please include area code.

Email

Reason for resignation; other comments

If after submitting this form you are not redirected to the homepage, please check to fill in any required fields that were not answered. Incomplete forms cannot be processed.