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?*

There is a minimum of 200 tickets, and can be increased in increments of 50.
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*
CAPTCHA

Dillingham

Ewa

Hilo

Kahala

Kahului

Kailua

Kaimuki

Kalihi

Kaneohe

Kapahulu

Kapolei

Koko Marina

Makiki

McCully

Mililani

Nimitz

Pearl City

Vineyard

Wahiawa

Waiau

Waipahu

Waipio

Dillingham

Ewa

Hilo

Kahala

Kahului

Kailua

Kaimuki

Kalihi

Kaneohe

Kapahulu

Kapolei

Koko Marina

Makiki

McCully

Mililani

Nimitz

Pearl City

Vineyard

Wahiawa

Waiau

Waipahu

Waipio

Benefit Fundraising

1. Organization Information

2. Number of Tickets

3. Applicant Information

A. Primary Applicant

B. Secondary Applicant

4. Other

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