Hensall Co-op Membership Application

Dear Applicant:

Thank you for applying to be a member of Hensall Co-op. If you are already a 
member, the information update form is available here. Our membership management team will 
contact you within 2 business days to get further confidential information.
Membership applications are reviewed at the end of each month by the Board of Directors. 
Acceptance of your application will be mailed to you, after approval by the Directors.  
In order to have charge privileges, an account application must be completed and approved 
as per our credit policy. 

You authorize and consent to Hensall Co-op to release your information as required to a third party.

Please complete the form online. You can print it after it is completed.

Fields marked with * are required.

Customer information

Firstname: *
Middle Initial:
Surname: *
Date of Birth: Month Day Year
Social Insurance Number (Non-Corporate):
Email Address: *
Telephone Numbers
Home Phone: *
Cellphone: *No Cellphone
Mailing Address
Street: *
City: *
Province: *
Postal Code: *

Business Info

Description of Business
Products & Services Used Feed
Crop Products

If Applicable

Legal Farm (Business) Name
Business Number (Corporation)
Type of business Sole Proprietorship

Membership Fees

Membership Fee: $50.00
Payment Method Charge my account Sending cheque

HDC Logo Hensall District Co-operative Inc.
1 Davidson Drive, P.O. Box 219,
Hensall ON N0M 1X0
TF: 1-800-265-5190 | T: 519-262-3002 | F: 519-262-2317