Membership Application

Complete your application for membership. All voting memberships must be approved by the board of directors. Please allow up to 30 days. Initial setup will be as non-voting member pending approval.

I am applying for:

 Non-Voting Membership
 Voting Membership (to be reviewed by Board)

Social Security numbers are required for us to report Patronage/Stock Earnings and Refunds to the IRS. If you decline, please read and initial: I understand by not providing my Social Security number, I waive all rights to Patronage/Stock Earnings and Refunds.

To comply with federal laws in reporting 1099 patronage dividends, we must report the social security or federal ID numbers of all patrons receiving dividends. If not reported, the Internal Revenue Service will assess the Snohomish Co-op $50 for each patron not in compliance. Please consult with a tax advisor on any tax implications in regards to patronage dividends.

Individual Consent & Subsitute Federal Form W-9

I hereby consent to include in my gross income, as now or hereafter provided in the Federal Income Tax Laws, the stated dollar amount of each written notice of allocation which I receive from : SNOHOMISH CO-OP, INC. with respect to my patronage occurring during the current and all past and subsequent taxable years of this cooperative. This individual consent shall be revocable by me at any time in writing.

 CHECK HERE IF YOU HAVE BEEN NOTIFIED BY THE IRS THAT YOU ARE SUBJECT TO BACKUP WITHHOLDING.

CERTIFICATION: Under penalties of perjury, I certify that the information provided on this form is true, correct and complete.