Member Resources New Member Form

2017 Niagara Local Food Co-op Registration


Thank you for your interest in becoming a member of Niagara Local Food Co-op. Niagara Local Food Co-op customers and producers are interested in local foods and products produced with sustainable practices that demonstrate good stewardship of the environment. To become a member, please read the Terms of Service, and then complete the following information and click submit.

If you are already a member, please sign in here. Otherwise fill out the form below to become a member. Required fields are shown with an asterisk (*)

Section 1: General Information
* First Name: * Last Name:
First Name 2: Last Name 2:
* Invoice Name:  
NOTE: Invoice Name can be edited. It will be used to route your order and should be easily tracable to you. It could be the common form of your name like "Alf Jones" instead of "Alfred Jones". If preferred, your Business Name may be used for the Invoice Name.
Business Name:  
I am interested in becoming a producer member for Niagara Local Food Co-op.  
Section 2: Contact Information
* Address:
Address 2:
* Locale: City
State
Zip
 
County (for tax purposes)
Work Address:
Work Address 2:
Locale: City
State
Zip
 
* Home Phone: Work Phone:
Mobile Phone: FAX:
Toll Free:    
* Email Address:
Email Address 2:
Home Page: http://
Section 3: Access Credentials
* Username: * Enter the word
Read this word to prove you are not a robot
Read this word to prove you are not a robot
* Password:
* Confirm:
Section 4: Membership Type
* Membership Type:
Producer member
Consumer member
Occasional shopper
No annual dues, but $10.00 will be added to each order.
Visitors are not be permitted to sell without upgrading to an annually-paid membership option.
Section 5: Additional Information
* How you heard about Niagara Local Food Co-op:
* Please give more detail:
What website, from whom, which publication/date, etc.?
YES! I‘m interested in volunteering to help Niagara Local Food Co-op.
* I acknowledge that I have read and understand the Niagara Local Food Co-op Terms of Service.