Green Bottle - Fundraiser Application Form

Fundraiser Information & Set-up Form

Please provide us some basic information about your potential upcoming fundraiser!


Customer Status	New Fundraising Inquiry
	If this is the first time you have contacted THE GREEN BOTTTLE, for a fundraiser, how did you find out about us?

	Have Already Partnered With Green Bottle For A Fundraiser

Organization Name
Organization Type
Contact First Name
Contact Last Name
Shipping Address
Shipping Address 2
City
State/Province/Territory	International Customers - Please select "Not in USA or Canada."
Zip or Postal Code
Country

E-mail Address
Repeat E-mail Address
	Please be careful to provide an accurate e-mail address. It is necessary to process your application.

Day Phone
Evening Phone
Cell Phone
Home Phone
Fax

What is the best time of day to reach you?

Who should your supporters make their checks payable to?

How do you want your fundraiser name to appear on order forms & posters?

Approximately how many sellers will you have?

When do you want your fundraiser to start?

When do you want your fundraiser to end?

	Billing Address (if different)
Address
Address 2
City
State/Province/Territory	International Customers - Please select "Not in USA or Canada."
Zip or Postal Code
Country

Thank you for completing our fundraiser registration form.
The information above is for our records and will not be shared with anyone.

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All Green Bottle™ products are free from the chemical Biphenol A (BPA) and do not alter the taste or smell of its contents.