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Change Membership Information

Please use this form to update your name, mailing address, email address and phone number.

Peninsula Co-op will retain your personal information only for as long as required to establish or maintain your membership, or as may be required by federal or provincial laws. We are committed to keeping your personal information up to date, accurate and relevant for its intended use. The information collected in this section of our website will be encrypted to protect your personal information.
Name*
First Last
Co-op Number*
Partial SIN
Middle 3 digits
Birth Month and Date
Contact Phone Number*
Consent
Check here ONLY IF you have a commercial credit, home heating or cardlock account
Partial SIN and Birthdate are requested for verification purposes. If you elect not to provide this information, Peninsula Co-op will contact you to verify your identity before changes to your membership can be made.
Choose the Types of Information to Change*
- Change Name
- Change Mailing Address
- Change Email Address
- Change Phone Number
New Name*
New First Name New Last Name
Document Upload*
Accepted file types: gif, jpeg, jpg, pdf, png, png.
First or last name changes require a copy of one legal document (ie. drivers license, marriage certificate, etc.). Accepted file types include GIF, JPEG, PDF and PNG. Files cannot exceed 10 MB in size.
New Address*
Full address including Postal Code
Previous Address*
Full address including Postal Code
New Email Address*
Previous Email Address*
New Phone Number*
Previous Phone Number*
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