Membership Application

Apply for H4BF COOPBOD Membership

H4BF COOPBOD Membership Application

Please complete the form below. Fields and categories follow the cooperative administrator registration form. Your application will remain pending until reviewed by H4BF COOPBOD.

Personal information

Full name *Email address (private) *Phone number (private) *SexBirth year (optional)Member categoryMembership package

Membership fees are configurable by the cooperative administrator. Confirm the approved fee schedule before accepting live payments.

Business / enterprise information

Business / enterprise nameBusiness typeIs the business legally registered?Business registration number (RCCM / other)Taxpayer number (NIU)

Address and location

CountryRegionDivisionSub-divisionVillage / city / communityPreferred collection / pickup pointQuarter / neighbourhood (enter directly)Latitude (optional GPS coordinate)Longitude (optional GPS coordinate)

Community map preview (appears when GPS coordinates are provided):

Enter GPS coordinates to preview this location on the map.

I confirm the information is accurate and agree that H4BF COOPBOD may contact me about this application and process the information for membership review.