Benefit Fundraising Form - Zippyʻs Restaurants

BENEFIT FUNDRAISING

Fields marked with an asterisk * are required.

ORGANIZATION INFORMATION

Name of Organization*

Number of Members*

Select one

Where is your organization located in?*

NUMBER OF TICKETS

How many tickets would you like*

There is a minimum of 200 tickets, and can be increased in increments of 50. ex 200, 250, 300, 350, etc.

Is your organization eligible for a GE Exempt rate?

Yes, my organization is eligible for a GE Exempt rate.

APPLICANT INFORMATION

Please provide 2 applicants who Zippy's may contact regarding your inquiry. Applicants must be over 18 years of age, living in different households and have full-time employment.

A. Primary Applicant*

First Name*

Last Name*

Mailing Address*

City*

State*

Zipcode*

Primary Phone*

Alternate Phone

Business Phone

Email Address*

Employer*

B. Secondary Applicant*

First Name*

Last Name*

Mailing Address*

City*

State*

Zipcode*

Primary Phone*

Alternate Phone

Business Phone

Email Address*

Employer*

Invoices will be emailed to the primary and secondary applicants listed above. If the email is different, include email here:

Email Address*

OTHER

Select one

How did you hear about our fundraising?

Select one

Area where tickets will be sold?*

Purpose of Fundraising

ORDER NOW