Begin Order
Organization Agreement: About you and our organization
Organization Name
*
Phone
*
Please enter a valid phone number.
Fax
Please enter a valid phone number.
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Shipping Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Group Name
*
Coordinator
*
First Name
Last Name
Title
Home Phone
*
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Email
*
example@example.com
Program Options
Please select from the following program options
Name to be on front of card
*
Preferred Delivery Date
-
Month
-
Day
Year
Date
Discount Card Program:
*
Please Select
The Standard - You get the sponsors
The Works - The Discount Card secures the sponsors
Pre-Sale Program
Super (other)
Total number of cards you are ordering:
*
Please Select
250
500
1000
1500
3000
Other (Super Saver):
Discounts from local businesses that will be honored for:
*
Please Select
6 Months
12 Months
Card Color Preferred
*
Please Select
White
Bright Yellow
Red
Orange
Green
Silver
Grey
Cranberry
Navy Blue
Medium Blue
Gold
Tan
Black
Ink Color Preferred
*
Please Select
Black
Red
Green
Gold
Silver
Blue
White
Other (Please Specify Below)
Other Ink Color (if preferred)
Agreement
*
I understand by filling out this form and clicking submit I am starting an order with the discount card.
Submit
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