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2022 New Roots New Shareholder Form
All answers given in this form are private. New Roots, as a policy, doesn't require any proof of income. This is all an honor system.
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Welcome!
First Name
*
Your answer
Last Name
*
Your answer
Street address
*
Your answer
City
*
Your answer
State
*
Indiana
Kentucky
Zip code
*
Your answer
Email address
*
Your answer
Phone number
*
Your answer
Do you anticipate using SNAP Benefits (Food Stamps, EBT) to pay for your share?
*
Yes
No
Maybe
If you selected maybe, provide further explanation.
Your answer
How many people are in your household? (Including you)
*
1
2
3
4
5
6
7
8
9+
What is your estimated annual Household income?
*
Your answer
Please ask us any questions or concerns you may have about becoming a shareholder.
Your answer
Thank you for filling out the new shareholder form!
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