Name

Phone # 

eMail 

Preferred method of contact:    Phone    eMail

Best time to contact you: 

1) What is most important to you in natural co-op?

     Select One Product Quality Price Convenience Availablity of Products Delivery Service

2) What do you think would be a reasonable annual membership fee for the co-op?

     Select One $25 $35 $50 $65 $75

3) What would make this statement true for you?

     "I would join the co-op if I could save at least 3% 6% 8% 10% on the groceries and
     household products I buy at other natural food stores."

4) Where do you currently purchase your natural foods (to select more than one, hold the 'Ctrl' key down and select all that apply)

     Select One Sprouts Whole Foods Fresh & Easy Sams or Costco Regular Grocery Other

5) How much do you approximately spend per week on these products?

     Select One $0-$50 $51-$100 $101-$150 $151-$200 $200 or more

6) Is having home delivery of your products important to you?  Yes    No

     If yes, what do you believe is a reasonable delivery charge for these products?

     Select One $10 $15 $20 $25 $30

7) Comments, Questions or Suggestions?

Thank you for your participation!