EQUITY REFUND REQUEST

Note: Equity investment refund requests are reviewed at the end of each fiscal year (June 30) and are at the discretion of the Grassroots Local Market Board of Directors. You will be contacted once your refund request has been reviewed and a decision has been made.


Please complete the following form with information for the member/stock holder: 

Member Name *
Member Name
Mailing Address *
Mailing Address
Phone *
Phone
Would you like to be removed from our email distribution list? *
Please allow 7 business days for processing.
Please select one of the following: *
To help better serve our member-owners, please let us know why you are requesting an equity investment refund from Grassroots Local Market. *
Sign and Verify *
I hereby certify that the information provided in this form is true and complete. I understand an equity refund request is being submitted to the Grassroots Local Market Board of Directors for review and that I am not guaranteed a refund. I understand that equity refunds are only reviewed at the end of each fiscal year (June 30) and I may not receive a decision on my refund request until after that date.
Date *
Date