Payment for Employee Discount Form

SETTING UP YOUR EMPLOYEE DISCOUNT

All employees are eligible to receive a 20% discount on groceries when shopping the Co-op. When you complete this form and start your first day at the Co-op, the Co-op will activate the discount for you on an account in our point-of-sale database. The account can be a Co-op Ownership that has your employee discount attached, or a stand-alone account that simply provides the discount to you free of charge. Once your discount is activated, all you need to do to receive the discount when you shop is provide either the account number or your name to the cashier at checkout.

Step 1: Watch the following video to learn more about the employee discount and Co-op Ownership

Step 2: Complete the Employee Discount Form

When you complete the form, you'll have the following options: to sign up for the employee discount only; sign up to have your employee discount attached to an existing Owner account; sign up to become an Owner today and have your employee discount attached to your new Co-op account. The form is broken down into several sections, and so don't forget to click "Next" at the bottom of each page until the form allows you to "Submit."

First Name *

Last Name *

Phone Number *

Address *

Address2

City *

State *

Zip *

Email *

Confirm Email *

Where were you hired to work at the Co-op? *

What day will be your first day working at the Co-op? *

Which age group are you in? *

I am under the age of 18.

I am 18 years of age or older.

Employee Discount for People Under the Age of 18

You must be at least 18 years of age to become an Owner of the Co-op. If you are not 18 years old, we can either set up your employee discount on a non-owner account in our point-of-sale system, or we can attach your discount to an existing Ownership an adult you live with already has with the Co-op.

Birth Date

Would you like to attach your employee discount to an existing Co-op Ownership in your household? *

Someone who lives with me has a Co-op Ownership account.

What is the Owner number for the person who lives with you? *

What is the name of the person who has this Ownership account? *

Last Name *

If you know of another person who is also listed on this Ownership account, please type their name here. It is okay if you do not know of another person listed on the account, however, if you are aware of a second person listed on the account, provid

Last Name

Terms *

Both the Owner of this account and I agree to the following terms and conditions when I submit this form: The person who owns this Ownership account lives with me, and they have consented to add my name and employee discount to their Owner account. If this Co-op Ownership has equity due, or is currently invalid, both the person who owns this Ownership and I will be notified by the Owner Records Administrator. If notified of the need to bring an Ownership up to good standing, the person who owns this account will make the necessary changes before my employee discount is applied to the account. If my living address does not match the address on the Owner account I provided, I understand that the person who owns this Owner account may be contacted to verify residence. If this person has an Individual Ownership, the person understands that they will be contacted to pay to change their account to a Household Ownership with an additional adult added (if I am under 18 years of age, this will happen when I turn 18 years old). Only people who live with me who are listed on this Ownership may use this Owner account that has the employee discount attached. Updates to this Owner account and who currently lives at the address associated with this Owner account can be made at the Customer Service desk at any Co-op retail location during open store hours. If anyone listed on this Owner account has questions about the account, about the employee discount, or about how to make changes, either I, or they, will contact the Owner Records Administrator at ora@willystreet.coop. I understand that the employee discount is detailed in the Employee Handbook and the details are subject to change. I certify the information provided to be true and commit to keeping the account number receiving the discount up to date, and I further understand that failure to inform the Co-op of changes to my eligibility or the account number receiving the discount may be grounds for disciplinary action. I understand that the employee discount is a benefit meant for the personal use of the people listed on my account only.

Terms *

I agree to the following conditions when I submit this form: I understand that a non-ownership account will be set up in my name to use when I shop so that I can receive a 20% discount on my groceries. A non-owner account card will be sent to the Site Director where I am working for the Co-op to give to me when my discount has been activated. I understand that when I use this account I will not be eligible for any other Owner benefits, and that I will not receive promotional prices for Owner-only sales. I understand that my non-ownership account is only for my use and I will not share my account number with anyone else. If I decide later that I would like to become an Owner, I understand that I can purchase a Ownership at the Customer Service desk at any Co-op retail location during open store hours or online at www.willystreet.coop/pages/ownership-registration. If I have questions about my employee discount, or about how to become an Owner, I will contact the Owner Records Administrator at ora@willystreet.coop. I understand that the employee discount is detailed in the Employee Handbook and the details are subject to change. I certify the information provided to be true and commit to keeping the account number receiving the discount up to date, and I further understand that failure to inform the Co-op of changes to my eligibility or the account number receiving the discount may be grounds for disciplinary action. I understand that the employee discount is a benefit meant for the personal use of the people listed on my account only

Employee Discount for People 18 Years of Age or Older

If you are 18 years of age or older, you are eligible to start your own Co-op Ownership and your employee discount can be added to your Owner account.

How would you like to receive your employee discount? *

I have an Individual Co-op Ownership.

I have a Household Co-op Ownership.

What is your Owner number? *

Someone who lives with me has a Co-op Ownership account.

What is the Owner number for the person who lives with you? *

What is the name of the person who has this Ownership account? *

Last Name *

Last Name

Individual Ownership

This Ownership is for one adult only. If you would like list another adult who lives with you to shop with this Owner account, please choose a Household Ownership.

Full payment of $58 today, no more payments ($56 is a full equity payment + $2 non-refundable administrative fee*)
*Payment in full saves you up to $12.00 in administrative fees.

$58.00 (Owner equity investment + $2.00 non-refundable administrative fee).

Household Ownership

Full payment of $93 today, no more payments ($91.00 for a full Household equity payment + $2.00 non-refundable administrative fee*)

*Payment in full saves you up to $12.00 in administrative fees.

$93.00 (Owner equity investment + $2.00 non-refundable administrative fee)

Individual Ownership

This Ownership is for one adult only. If you would like list another adult who lives with you to shop with this Owner account, please choose a Household Ownership.

Annual Partial Payments $10 each year for 7 years ($8.00 investment towards a full Individual equity payment + $2.00 non-refundable administrative fee), for a maximum payment of $70.00 ($56.00 Owner equity investment + $14.00 administrative fee).

$10.00 (Owner equity investment + $2.00 non-refundable administrative fee).

Household Ownership

Annual Partial Payments $15 each year for 7 years ($13.00 investment towards a full Household equity payment + $2.00 non-refundable administrative fee), for a maximum payment of $105.00 ($91.00 Owner equity investment + $14.00 administrative fee).

$15.00 (Owner equity investment + $2.00 non-refundable administrative fee).

Ownership Type *

Date of Birth *

Would you like to have your receipts emailed to you? (you can still request a printed receipt at checkout) *

Would you like to receive the Reader (our monthly newsletter) by email or mail? *

Have you ever been a Willy Street Co-op Owner in the past? *

Yes

What prompted you to become an Owner? *

They can receive a gift card! Please provide this information:

Name *

Email or Phone *

Please Explain *

Terms and Conditions

Terms of Service

Thank you for becoming an Owner of Willy Street Grocery Co-op! As an Owner of this grocery cooperative, we encourage you to offer suggestions, ask questions, vote in elections and participate in Co-op events to help make it even more the organization that you want it to be.

REFUNDS:

The Owner equity amount is redeemable to the owner within 90 days of written resignation from the Co-op (as specified in Section 3.10 of the WSGC Bylaws). I agree that if I fail to request a refund of my Owner equity account the funds in the account may be forfeited to WSGC as specified in Section 185.03(10) of the Wisconsin Statutes. My Owner equity account may not be forfeited to WSGC until at least three years after my ownership has terminated, and only if at least 60 days in advance of such forfeiture WSGC notifies me, at my last known address, of the potential date of such forfeiture, and I still fail to request a refund.

Bylaws that pertain to the Fair Share Contract:

SECTION II: PURPOSE

2.1: The purpose of the Co-op is to serve the needs of its Owners. Its primary focus is to operate a grocery business providing nutritious food to the community at fair prices. Consistent with that focus, it may also engage in other activities and provide other goods or services as may be desired by the Owners.

SECTION III: OWNERSHIP

3.1: The Co-op shall have one class of Owners. “Owners” in these bylaws is equivalent to and used in place of the term “members” as used in Chapter 185.

3.2: Ownership in the Co-op shall be voluntary and open to any person, household, cooperative or non-profit corporation that wishes to support the Co-op’s activities, intends to use its services, and will accept the responsibilities of Ownership. Persons entering into an Ownership must be at least 18 years of age and capable of accepting the legal responsibilities of Ownership.

3.3: The Co-op shall not discriminate on the basis of age, race, color, sex, sexual orientation, gender identity, religion or atheism, national or ethnic origin or ancestry, citizenship status, political beliefs, veteran status, disability status, marital status, source of income, arrest record, conviction record, less than honorable discharge, physical appearance, genetic identity, familial status, student status, domestic partner status, receipt of rental assistance, refusal to disclose their social security number, homelessness, unemployment status or any other category protected by local, state or federal law.

3.4: Submitting a completed Ownership application and payment towards an Owner equity share is required in order to become an Owner. An application for Ownership may be subject to approval by the Board of Directors.

3.5: The Owner equity share is the dollar amount that is required to purchase an Ownership share. The Board of Directors may make provisions allowing the purchase of this share in installments over time and may allocate a portion of each payment as a non-refundable administrative fee. Any change to the amount of the Owner equity share shall be approved by the Owners using the signed ballot process described in Section 4.7.

3.6: An Owner is considered to be current and in good standing if the Owner has made a purchase at least once in the past 12 months and either the Owner equity share is paid in full or the required installment payments have been made.

3.7: Ownership may be terminated voluntarily by an Owner at any time upon written notice to the Co-op. Ownership will be considered voluntarily terminated if not kept current.

3.8: Ownership may be terminated involuntarily only for cause by the Board of Directors. “For cause” termination must be based upon seriously improper conduct that must include at least one of the following circumstances:

A willful failure to deal fairly with the Co-op in connection with a matter that the Owner has a material conflict of interest;
A violation of criminal law at or in connection with activities of the Co-op;
A transaction with the Co-op from which the Owner derived an improper personal benefit;
Willful misconduct or disruptive behavior that results in the Co-op serving a written notice of trespass to the Owner.

Person(s) who have had their Ownership terminated involuntarily may make an appeal in writing within 30 days of written notice of termination. Appeals may include a statement or other information in support of their request for reinstatement. Following receipt of appeal, the Board of Directors may, at their discretion, invite the person(s) to make their appeal in person. The Board of Directors may make decisions regarding reinstatement of Ownership in closed session.

3.9: Upon termination of Ownership, all rights and interests in the Co-op shall cease except for rights to redemption of their Owner equity share funds in accordance with these bylaws.

3.10: The balance existing in each Owner’s Owner equity share account is refunded upon termination of Ownership, within 90 days, subject to the Board of Directors determining when money is available for refunds and how much may safely be refunded each fiscal year.

3.11: Ownership rights and interests, including any Owner equity share balance, may not be sold, assigned or otherwise transferred in any way to another person or entity except as provided for by the Board of Directors.

3.12: The Board of Directors may establish other categories of patrons that may from time to time be extended certain Owner benefits, such as being able to make purchases at promotional Owner prices, without having purchased an Owner equity share, however these designations will not bestow any right to vote or to be elected to the Board.

Terms *

I agree to the following terms & conditions when I submit this form: If my Co-op Ownership has equity due, or is currently invalid, I will be notified by the Owner Records Administrator and I will make the necessary changes to bring my Ownership up-to-date before my employee discount is applied to the account. Because I have an Individual Ownership, I am the only person who will use my Owner account that has the employee discount. If I have children under the age of 18 living in my household who need to use my Ownership, I will ask the Owner Records Administrator to add their names to my account. If I have other adults 18 years of age or older living in my household who need or would like to use my Ownership, I will upgrade to a Household Ownership and pay the additional Owner equity and fees to add them to my account. Updates and/or upgrades to my Owner account can be made at the Customer Service desk at any Co-op retail location during open store hours. If I have questions about my Owner account, about the employee discount, or about how to make changes to my Owner account, I will contact the Owner Records Administrator at ora@willystreet.coop. I understand that the employee discount is detailed in the Employee Handbook and the details are subject to change. I certify the information provided to be true and commit to keeping the account number receiving the discount up to date, and I further understand that failure to inform the Co-op of changes to my eligibility or the account number receiving the discount may be grounds for disciplinary action. I understand that the employee discount is a benefit meant for the personal use of the people listed on my account only.

Terms *

I agree to the following terms and conditions when I submit this form: If my Co-op Ownership has equity due, or is currently invalid, I will be notified by the Owner Records Administrator and I will make the necessary changes to bring my Ownership up-to-date before my employee discount is applied to the account. Only people who live with me who are listed on my Household Ownership may use my Owner account that has the employee discount. Updates to my Owner account and who currently lives with me and can use my Owner account can be made at the Customer Service desk at any Co-op retail location during open store hours. If I have questions about my Owner account, about the employee discount, or about how to make changes to my Owner account, I will contact the Owner Records Administrator at ora@willystreet.coop. I understand that the employee discount is detailed in the Employee Handbook and the details are subject to change. I certify the information provided to be true and commit to keeping the account number receiving the discount up to date, and I further understand that failure to inform the Co-op of changes to my eligibility or the account number receiving the discount may be grounds for disciplinary action. I understand that the employee discount is a benefit meant for the personal use of the people listed on my account only.

Terms *

Terms

I agree to the terms of service and to become an Owner of Willy Street Co-op when I submit this form. My contact information is used for communication between Co-op staff and me. I understand the Co-op will not sell my information. I understand that the employee discount is detailed in the Employee Handbook and the details are subject to change. I certify the information provided to be true and commit to keeping the account number receiving the discount up to date, and I further understand that failure to inform the Co-op of changes to my eligibility or the account number receiving the discount may be grounds for disciplinary action. I understand that the employee discount is a benefit meant for the personal use of the people listed on my account only.

Terms *

Total Amount

Payment method

Clover Hosted Checkout

Billing Zipcode*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*

Main Menu

Payment for Employee Discount Form

SETTING UP YOUR EMPLOYEE DISCOUNT

Step 1: Watch the following video to learn more about the employee discount and Co-op Ownership

Step 2: Complete the Employee Discount Form

Employee Discount for People Under the Age of 18

Someone who lives with me has a Co-op Ownership account.

Employee Discount for People 18 Years of Age or Older

I have an Individual Co-op Ownership.

I have a Household Co-op Ownership.

Someone who lives with me has a Co-op Ownership account.

Individual Ownership

Household Ownership

Individual Ownership

Household Ownership

Terms and Conditions

Terms of Service

Bylaws that pertain to the Fair Share Contract: