Park Region Coop

New Customer

Become a member and earn patronage dividends. Each year we pay out 30% in cash and 70% in stock equity. We are proud to be one of very few co-ops that pay out stock equity on a six-year revolving basis.

Forms

Please return forms marked with an **

Convenience Store Customer

• **Convenience Store Credit Application (PDF, 382.92 KB)
• **W-9 Form complete to be eligible for dividends) (PDF, 127.55 KB)

Propane Customers

• **Credit Application (PDF, 385.10 KB)
• **Propane and Out of Gas Acknowledgement
• **W-9 Form (complete to be eligible for dividends)
• Propane Safety Information
• Out of Propane Policy

Fuel Oil Customers

• **Credit Application
• **Out of Fuel Oil Acknowledgement
• **W-9 Form (complete to be eligible for dividends)

Business Customers

• **Business Credit Application