Close Membership

After completing this form, our membership coordinator will reply via email to confirm receipt of your request and verify your refund amount (if any). Refund checks are mailed four to six weeks from date of closing.

"*" indicates required fields

Name*

First Last

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of birth

My member number is

If you don’t know your member number, please email [email protected] or visit the store so we can look it up for you.

I request a refund of my equity investment (select option)*

I want to receive an equity refund

I would like to donate my equity investment to the Farm Fund

Reason for closing membership

Moving Away

Becoming a Senior Member

Dissatisfied with Member Benefits

Dissatisfied with Staff or Store

Dissatisfied with Store Policy

Can’t Afford

Multiple Accounts

Other reason for closing membership

We’ll miss you! Please tell us why you are leaving.

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