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Risk Free Brochure Fundraising Sign-up Form

*Required Fields

Organization Information
First Name: Required*
Last Name: Required*
Email: RequiredInvalid format.*
Organization Name: Required*
Address: Required*
Address cont:
City: Required*
State: Please select an item.*
Zip: RequiredInvalid format.*
Sponsor Information
Sponsor First Name: Required*
Sponsor Last Name: Required*
Title Required*
Alternate Contact: Required*
 *Must be at least 18 years old (required)
Day Phone: RequiredInvalid format.* Ext:
Evening Phone Invalid format.
Fax: Invalid format.
Sale Information
Number of Participants Please enter a number*
NYS clients please add tax ID #:
Please Select Your Brochure:
Date Brochures Needed: RequiredInvalid format.*
Start Date of Drive: RequiredInvalid format.*
End Date of Drive: RequiredInvalid format.*
The Organization has an option of receiving prizes for
participants or a 2% rebate off the invoiced amount:
Prize Program
2% Discount on your order
* selection required
Additional Information
Additional Comments or Questions:

This Agreement, made on this DATE: Saturday, December 15, 2018 01:42:34 EST, by and between Tracy Hamilton Inc. ("Distributor") also doing business under the name, and ("Organization"). Distributor and Organization hereby agree to the following:

The above listed Organization will abide by the terms and conditions contained within this agreement and are hereby agreed upon by Tracy Hamilton Inc, the Organization and the undersigned sponsor of this agreement.

RequiredI agree to the terms listed above. *
RequiredYour Initials *

Your privacy is of the utmost importance to our company, especially in these times of identity theft. Our company values the trust you have placed in us - we take it seriously. We will not rent, trade or in any way market your personal information to any third parties for the purpose of financial gain.