Name *

Each owner share lists one individual as the primary owner, and other individuals are listed as household members. Only the primary owner on the account can edit contact information. Household members are not authorized to make changes to the account. If your original share paperwork lists a different name as the primary owner other than the name entered below, we'll reach out to the primary owner for confirmation.

First Name

Last Name

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

Please provide the best phone number to reach you during business hours.

(###)

###

####

Did Your Name Change?

If your name has changed, please enter the name currently listed on your account.

First Name

Last Name

Would you like to add or remove a household member?

A household means a housekeeping unit consisting of one or more adults and any number of dependent children. All household members listed on the account are authorized to: make purchases, use owner coupons, and apply applicable patronage dividends at checkout.

Add

Remove

Household Member

First Name

Last Name

Would you like to receive newsletters and promotions via email? *

By selecting yes, you authorize Medford Food Co-op to send promotional content to the email address provided. You may unsubscribe at any time. By selecting no, you opt-out of receiving promotional content that includes notifications about owner benefits.

Yes

No