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

Benefit Fundraising