Fundraiser – Rampage Coffee Co.

Full Name*

Email Address*

Phone Number*

Organization/Group Name:*

Role in the Organization:

Fundraising Goal:

Purpose of Fundraising:

Estimated Number of Participants:

Preferences & Inquiries about the Products:

Any Dietary Restrictions or Concerns:*

Questions/Comments about the Products:

Date:*

Preferred Shipping Address:House or Business # / Street / City /Prov / Postal code

Would you require separate shipments to individual participants?

Yes

How did you hear about our fundraising program?

What do you hope to achieve with our fundraising program?

Do you know other groups or individuals who might be interested in this opportunity?