Benefit Fundraising Form - Zippy's Restaurants

Fields marked with an asterisk * are required.

1. Organization Information
Name of Organization*
Number of Members*
How would you like to receive your invoice? (Check one)*
- Email
- Regular Mail
Email invoice to:*
Mailing Address*
Street Address City State ZIP Code
2. Number of Tickets
How many tickets would you like?*
Tickets come in sets of 50 with a minimum of 200 tickets.
Your organization could make $800.

$1000 owed to Zippy's.

200 tickets, sales price per ticket is $9.

The above amounts are estimates before taxes.

For ticket orders of 700 or more, contact us today at (808) 973-0880 or email fundraising@zippys.com for more information.
Is your organization eligible for a GE Exempt rate?
- Yes, my organization is eligible for a GE Exempt rate.
3. Applicant Information
Please provide 2 applicants who Zippy's may contact regarding your inquiry. Applicants must be over 18 years of age, and living in different households.
A. Primary Applicant
Primary Applicant Name*
First Name Last Name
Mailing Address*
Address City State ZIP Code
Primary Phone*
Alternative Phone
Business Phone
Email Address*
Employer*
B. Secondary Applicant
Secondary Applicant Name*
First Name Last Name
Mailing Address*
Address City State ZIP Code
Primary Phone*
Alternative Phone
Business Phone
Email Address*
Employer*
4. Other
How did you hear about our fundraising program?
Other*
Area where tickets will be sold? (Check one)*
- Honolulu
- Windward
- Leeward
- Hilo
- Kahului
- ALL
Purpose of Fundraising*
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Benefit Fundraising