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WAYS TO APPLY

MAIL
Mid Island Co-op
Administration Office
2517 Bowen Road, Unit 103
Nanaimo, BC V9T 3L2

FAX
250-729-8426

ONLINE
Fill out and submit the
form on the right.

IN PERSON
Stop by any of our 14 
locations to fill out
an application.
Join Co-op - Sign up Form (*All fields required)
Individual or Organization*
Organization Name*
Business #*
Officer Name*
Title*
First Name*
Last Name*
Date of Birth (MM/DD/YYYY)*
Social Insurance Number* ?
Your social insurance number is used by Mid Island Co-op to report the withholding tax deducted from your rebate, thus allowing the Canada Revenue Agency to correctly allocate this remittance to your personal account, which you may then claim back when you file your income tax return.
Home Phone*
Cell Phone
Work Phone
Email*
Address*
City*
Province*
Postal Code*
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