Change or Update 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

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.

Contact Phone Number*

Consent

Check here ONLY IF you have a commercial credit, home heating or cardlock account

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, Max. file size: 10 MB.

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*

Street Address City Province 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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Important member info
Co-op promos & offers
Liquor promos & offers (must by 19+)
Online voting for Directors Election

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Change Membership Information