Name of Organization:

(This is what will be printed on your fundraising packages)

First Name:

Last Name:

Address 1:

Address 2:

City:

State:

Zip:

Contact Person First Name:

Contact Person Last Name:

Day Phone:

Evening Phone:

Fax Number:

Number of Participants:

Number of Sales Brochures:

Fundraiser Start Date:

Fundraiser End Date:

Date Fundraiser Brochures are Needed:

If someone pays for the Classic Cookie® product by check, whom do you want them to make their checks payable to?
(Checks must be made payable to your organization)

What address will the Classic Cookie product be delivered to?

Location:

Address 1:

Address 2:

City:

State:

Zip:

E-mail Address:

Confirm E-Mail Address:

What special information would you like printed on your customized flyer? (Examples: Goals for your organization or participants? What are you raising money for?)

 The Original Collection

Choose Your

Fundraising Collection(s):

 The Reserve Collection

 The Soothing Collection

 The Collections Catalog

Would you like to add a Pre-Portioned Cookie Dough product?

 Yes   No

Would you like to add a Brownie Dough product?
(N/A if Collections catalog selected.)

 Yes   No

Would you like to add a Mason Jar (candle)?
(N/A if Soothing catalog selected.)

 Yes   No

* Items in red are required fields.