Owner Withdrawal Form

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Sorry to see you go! We truly appreciate your patronage. Please complete the below form to redeem your $80 ownership share.

Owner Statement

I am an owner of the Lexington Co-op and wish to withdraw my ownership and redeem my equity share in the Co-op. I understand that I will no longer enjoy the benefits of ownership from the date that my ownership share is refunded.

I also understand that redemption proceeds shall be subject to be offset by amounts due and payable to the Co-op by the owner.

Owner Name: *

Owner Number: *

Today's Date: *

YYYY

Amount paid toward owner share:

$20

$40

$60

$80

I don't know

Other:

Clear selection

Address: *

City/Town: *

State/Province: *

ZIP/Postal Code *

Phone Number: *

E-mail Address: *

Why are you withdrawing your Co-op ownership? *

I no longer shop at the Co-op.

I am moving out of the area.

I am dissatisfied with the Co-op.

Other:

Required

Submit

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