BBTWD Pay It Forward
Fundraiser Submission Form
"*" Indicates required field
REPRESENTATIVES CONTACT INFORMATION
First Name:
*
Last Name:
*
Contact Number:
Email:
*
(xx@xxx.xxx)
How did you hear about BBTWD Pay It Forward?
Facebook:
Twitter:
BBTWD website:
Friend/Colleague
Radio:
TV:
Other:
CAUSE/ORGANIZATION INFORMATION
Name of Cause or Organization
*
Website Address
Brief explanation of the cause you are supporting with BBTWD Pay It Forward.
Who do we pay and where do we send the disbursement check?
Payee Name:
(As to appear on check)
*
Payee Street Address
*
Payee City
*
Payee Contact Number:
*
Payee State:
*
Payee Zip Code
*
Enter the code above here :
*
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