Owner Equity Withdrawal

Owner's Name(s):*
Today's Date:
Owner Number:*
I hereby withdraw as an owner of Astoria Co+op. I ask that the co-op refund my shares.
Signature
Your Name
Your Name
Your Name
Mailing Address:
Street Address City State / Province / Region ZIP / Postal Code Country
Email
I am withdrawing our ownership from Astoria Co+op for the following reasons:
- Moving out of the area
- No longer shopping much at the co-op
- Need money for something else
- Dissatisfaction (please explain):
I’ve always wanted to praise:

Community Owned.Everyone Welcome to Shop!