PENINSULA CO-OP
MEMBER-OWNER APPLICATION
FOR A ONE-TIME $27 INVESTMENT ($25 SHARE PURCHASE + $2 ADMINISTRATION FEE)
YOU RECEIVE A LIFETIME PENINSULA CO-OP MEMBERSHIP
In accordance with the acceptance of this application by the Board of Directors, I hereby agree to comply with the Rules of
the Co-operative as they are now, and recognize that they may be amended by the members and Board of Directors.
Last Name: ______________________________________________
First Name: _____________________ Middle Initial: ___________
Business Name/Community Group: ________________________________________________________
BIN:________________________
(Complete business/community information only if membership is to be in that name)
Address: ___________________________________________________________________________________________________________
City:_________________________________ Province:______________________________
Home/Cell Phone:_____________________ Postal Code:___________________________
Month
Day
Year
Work Phone:___________________________Birthdate:_____________________________
SIN# (for income tax purposes only*): _____________________________
Email: __________________________________________________________________
*Your social insurance number is used by Peninsula Co-op to report the witholding tax deducted from your rebate, thus allowing Canada Revenue Agency to correctly
allocate this remittance to your personal account, which you may be able to claim back when you file your income tax return.
I would like to “opt-in” to receive the following email information:
Newsletters
Promotions
Announcements
Election/AGM
Research
Signature: ________________________________________________ Date:____________________________________________________
■
Do you currently use home heating oil?
Yes
No
Supplier: _________________________________________________
How did you hear about Peninsula Co-op?
Friend or Family
Drive By
Newspaper
TV
Radio
Website
Social Media
If a current member of Peninsula Co-op told you about us, please provide the following information so we can send them a
$10 gift card to express our appreciation.
Member’s Name: ____________________________ Address: __________________________________ Member #: _________________
Staff Member’s Name:______________________________________Location:_________________________________________________
When you apply for a Peninsula Co-op membership, certain information is collected for the following purposes: Verifying your eligibility for membership; establishing
and maintaining your membership; accounting services; communicating with you regarding your membership or other matters of concern to the Co-op and its members;
detecting, preventing and deterring fraud; compiling statistics; offering you products and services to meet your needs and meeting legal and regulatory requirements.
Some of your information may be shared with a third party, for example, to facilitate the mailing of your member rebate. The information will only be that of which
is necessary for completion of that purpose. Your signature on this application form indicates your consent to the use of the collected information. The security
of your information is a high priority for Peninsula Co-op and we maintain appropriate safeguards to protect it.
OFFICE USE ONLY
Receipt #:____________________________ Received By:__________________________ Customer Service Stamp Only:____________
Location:_____________________________ Date Payment Rec’d:___________________ Co-op Member #:______________________
Month
Day
Year
Place membership # sticker here
Revised 04/08/2015
Staff - tear off bottom portion along perforation and give to new member.
PENINSULA CO-OP MEMBER-OWNER PROGRAM
In 2014 member-owners received a 5% rebate on their grocery purchases and a 4.9¢ per litre rebate on their Co-op gas and home heating purchases. Of the December 2014
rebate, 60% was allocated and paid out in a cheque to member-owners at rebate time. The remaining 40% is retained in each member-owners share account for a minimum
of 5 years and will be paid in the 6th year providing the Co-op financial position remains strong. The rebate for Cardlock and participating Save-On Gas petroleum purchases
in the 2014 fiscal year was 2.45 cents per litre or 2%.
LOYALTY vs MEMBER-OWNER PROGRAM COMPARISON
Retailer
Equivalent
Value per Litre
Equivalent Value on
$3,500 Spending
Petro Points
0.42¢
$10.88
Esso Points
0.58¢
$15.00
Shell Air Miles
0.52¢
$13.50
Peninsula Co-op
ownership rebate
4.9¢
$127.00
The above comparison assumes a $1.35 per litre street price (including GST) on regular gas and
November 2014 competitor’s website information (excludes competitor’s bonus offers).
PENINSULA CO-OP
MEMBERSHIP CARD
Member’s Name: ______________________________
Member #: ___________________________________
Place membership # sticker here
This is your temporary membership card.
Your permanent card will be sent in the mail to you.