We are committed to protecting and securing client confidentiality. Information provided will never be disclosed to other parties.

Your Information
*Name:   *Day Phone:  
Title:   *Evening Phone:  
*Email:   Best time to call:  

Organization Information
*Organization Name:   *State/Prov.:  
Type of Organization:   *Zip/Postal:  
*Street Address:   *Country:  

Your Project Details
*Desired Start Date:   *Number of Participants:   
 If you are ordering more than 250 units, do you desire a four page full-color Custom Liner Booklet inserted  within your order?   Yes     No

 Program Format

 Choose Your Program Format: Webstore and Pre-Sell or Advance Ship

Advance Ship

 Please confirm the Name of the Organization that this fundraising is for, if it is not directly for the applicant or  his/her organization: . We reserve the right to qualify prospective applications,  and we require confirmation that the funding is for the respective organization. A letter from the school, youth  organization, or athletic club receiving the funding will be sufficient. Program acceptance will be acknowledged  after verification is confirmed, and no charges or invoices will be issued until after this is processed and you have been notified.

 How did you hear about us?      Source:

 Do you have any Comments, Future Selection Requests or Suggestions?

 Do you want to receive a copy of this Form submission?   Yes     No

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