Membership Application

Date

Name

Address

City, State, Zip

Choose Class A or B

Class A entitles you to:

Patronage dividends

Eligible to Vote

Eligible to serve on Board of Directors

Class B entitles you to:

Patronage dividends

Non-Voting status

Please Describe:

For Administrative Use Only

Business activity discussed and evaluated

Business account set up with North Iowa Cooperative or United LP Co.

Final approval by the Board of Directors

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