Full Share of Member Equity - $150 Member Equity Installment Plan ($15/mo for 10 months)

Return this form with your equity payment to a

cashier or mail to: The Old Creamery, 445

Berkshire Trail, Cummington, MA 01026. Make

checks payable to: The Old Creamery Co-op

You will receive a member number card and a

welcome packet in the mail.

Name:

___________________________________

Name(s) of other adults in your household

included in this membership:

___________________________________

___________________________________

___________________________________

Mailing Address:

___________________________________

City: _______________________________

State: __________ Zip: _______________

Phone: _____________________________

Email: ______________________________

Do you want to receive our e-newsletter?

Yes ___ No ___ I already receive it _____

I accept that my rights as a Member-Owner of the

cooperative are subject to the bylaws of The Old

Creamery Co-op as they may be amended from

time to time. A current copy can be downloaded at

www.oldcreamery.coop or I can request a copy in

the store.

Signature______________________________

Date________________

Community-Owned,

Everyone Welcome!

OFFICE USE: □COPOS □CC □CARD □LETTER □PHONE

REFERRAL NAME:__________________________________