SECTION A: General Statement of Business Operations
1. Principal commodities, or products, handled by the cooperative: _______________________________________
____________________________________________________________________________________________
2. The cooperative has offices in the following states: __________________________________________________
____________________________________________________________________________________________
Stock Association Non-Stock Association
Number of Stockholders: Number of Members:
Capital Stock Paid Up: Membership Fees:
SECTION B: Officers and Directors (attach a separate sheet if additional space is needed)
Name:
President
Telephone # and Extension
E 911 Address (physical street location): U. S. Postal Address (P. O. Box, etc.):
City: State: County: Zip Code:
Name:
Telephone # and Extension
E 911 Address (physical street location): U. S. Postal Address (P. O. Box, etc.):
City: State: County: Zip Code:
Name: Telephone # and Extension
E 911 Address (physical street location): U. S. Postal Address (P. O. Box, etc.):
City: State: County: Zip Code:
Name: Vice-President / Secretary /
Treasurer / Director (Circle One)
Telephone # and Extension
E 911 Address (physical street location): U. S. Postal Address (P. O. Box, etc.):
City: State: County: Zip Code:
Name: Vice-President / Secretary /
Treasurer / Director (Circle One)
Telephone # and Extension
E 911 Address (physical street location): U. S. Postal Address (P. O. Box, etc.):
City: State: County: Zip Code:
Name: Vice-President / Secretary /
Treasurer / Director (Circle One)
Telephone # and Extension
E 911 Address (physical street location): U. S. Postal Address (P. O. Box, etc.):
City: State: County: Zip Code:
Vice-President / Secretary /
Treasurer / Director (Circle One)
Vice-President / Secretary /
Treasurer / Director (Circle One)