*Account name should match to the Fed ID/ SS#; this is how the 1099 will be filed*
Mail Payment To: Cooperative Farmers Elevator Attn: Membership Processing, PO Box 37 Rock Valley, IA 51247
I, the undersigned, do hereby certify that I am eligible for Class A Membership in Cooperative Farmers Elevator and that I am an active agricultural producer (as referred to in the Amended and Substituted Articles of Incorporation). I understand that Class A Members are the owners of the Coop, have voting privileges, and can receive a dividend from profits on business done with the coop.
BY CHECKING THE BOX AND SIGNING MY NAME BELOW, I CONFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE, AS WELL AS ALL TERMS, LATE CHARGES AND LEGAL CONDITIONS CONTAINED HEREIN.
I, the undersigned, do hereby certify that I am eligible for a Class B Membership in Cooperative Farmers Elevator, which qualifies me to receive patronage on the Merchandise that I purchase from the coop.
I do further consent that any patronage dividend allocations made to me with respect to purchases made by me or the sales of the coop, which are made in written notices of allocation (as defined in Section 1388 of the US Internal Revenue Code as amended by the Revenue Act of 1962), will be taken into account by the undersigned at their stated dollar amounts in the manner provided in Section 1385(a) of the US Internal code in the in the taxable years which notices of allocation are received from this coop.
The foregoing shall be fully effective and irrevocable upon acceptance by the Board of Directors of Cooperative Farmers Elevator. I also understand that if I cease to patronize this coop for two consecutive years, I will become ineligible for membership and my share may be cancelled and transferred to my stock credits or paid out without other notice than this agreement.
BY CHECKING THE BOX ABOVE AND SIGNING MY NAME BELOW, I CONFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE, AS WELL AS ALL TERMS, LATE CHARGES AND LEGAL CONDITIONS CONTAINED HEREIN.
