Gordon Industries Specialties and Gifts Emporium Fundraising Form

Please complete each item.

Date:

Name of Organization:

Address:

City:

State or Country:

Telephone(Area code first):

Type of Organization (Adult/Youth:

Is this an ongoing project? (Yes or No):

Date fund-raising is to start:

Date fund-raising is to end:

Person in charge of the Fund-Raising Program.

First name:

Last name:

Address 1:

Address 2:

City:

State:

Zip Code:

Country:

Providence(If Applicable):

Email address (If Applicable):

Telephone(Area code first):

Catalogs Needed:

Referrer Code (If Applicable):

Comments: