Fundraising Request Form

Fundraising Information Request Form

Simply fill out the form below and we'll be happy to send you information on how

your organization can raise funds using the LocalBenefits Rewards Card.

items in BOLD required

**First Name:**
**Last Name:**
Organization Name:
City:
County/Parish:
State:
Zip/Postal Code:
Phone:
Contact E-mail:

How did you hear about us?
Nature of this request
Purpose of Fundraising:
Fundraising Goal ($ Amount):
# of Volunteers who will be selling:
Date you wish to start:
Are you interested in selling the cards or sending home the fundraising letter/flyer?:
Please include any comments or questions:

write SATURDAY in the block to the right. (ALL CAPS):	to help us avoid spam

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