HundredX Causes Program Application

HundredX Causes Program Application

To complete this application, you'll need the following information: contact information for the contract signer & treasurer, W9, Tax ID/EIN number.
Organization Name*
Organization Website*
Organization Address*

Street Address

Street Address Line 2

CityState

Zip Code
Your Contact Info
Name*

First NameLast Name
Email*
example@example.com
Role in Organization*
Will you be the primary contact for the organization?*

YesNo
Has your organization participated in a HundredX Causes program before?*

YesNo
Is your organization ok with receiving funds via ACH*

YesNo
Prior Program Information
Can you log into your Bill.com account?*

YesNoUnsure
Please provide your Bill.com PNI (Payment Network ID) number: *
The PNI number is found in your Bill.com account under Settings > company profile > scroll to bottom.
Has your organizations W9 information changed?*

YesNo
Organization & Program Info
In which state is your Organization based?*
Where are your Organization's supporters primarily located ?*
In which states does your Organization have supporters?*
Please select all that apply. (Hold down the Control key to select multiple states)
Type of Organization*
How many people do you expect to opt-in and participate in this HundredX Causes program?*
If selected to participate, is there a particular month that would work best for your organization?*
Please select which timefame within the above month you'd prefer to start:*
Beginning of month programs generally start on the 1st of the month or the first Monday. Mid-month programs begin on the 3rd Monday of the month. Programs run for 30 days.
How did you hear about HundredX Causes?*
Please provide a brief description (1-2 sentences) about the mission of the organization. *
Please provide a brief description (1-2 sentences) regarding how any generated funds will be utilized.*
Does your organization engage regularly with your supporters?*

YesNo
How do you communicate with your supporters? (Check all that apply)*

Social MediaEmail Marketing or NewslettersIn-Person EventsText Messaging
Who will be the contract signatory for this program?*

MyselfAnother Person
Contract Signatory

The individual authorized to sign the contract on behalf of the organization.
Signatory Name*

First NameLast Name
Signatory Email*
example@example.com
Signatory Phone*
Please enter a valid phone number.
Who will be the Treasurer for this program?*

MyselfAnother Person
Treasurer

The designated individual must have access to the organization's bank account information. HundredX will send a Bill.com connection request to this contact for new causes and for returning causes who cannot log in to their existing Bill.com account.
Treasurer Name*

First NameLast Name
Treasurer Email*
example@example.com
Treasurer Phone*
Please enter a valid phone number.
Does your organization meet the requirement for tax exempt status as determined by the IRS?*

YesNoUnsure
Please enter the Tax ID/Employer Identification Number (EIN) here:*
This is found on the W9. It is the 9 number Tax ID/EIN. XX-XXXXXXX
Please upload your a current, signed version of your W9.*

In order to receive payment for any eligible feedback collected, we are required to collect your W9. Failure to upload a W9 will result in a delay in evaluating your application for a program. You can download a W9 form here: https://www.irs.gov/forms-pubs/about-form-w-9
Cancelof
Are there any Program Leaders who should also have access to the program for planning purposes?*

YesNo
Program Leader
Program Leader Name

First NameLast Name
Program Leader Email
example@example.com
Program Leader Phone
Please enter a valid phone number.
Program Leader Role in Organization*
Are there any other Program Leaders who should also have access to the program for planning purposes?*

YesNo
Additional Program Leader
Additional Program Leader Name

First NameLast Name
Additional Program Leader Email
example@example.com
Additional Program Leader Phone
Please enter a valid phone number.
Additional Program Leader Role in Organization*
Terms & Conditions*

By submitting this application, you understand that a HundredX Causes program is not guranteed and agree to HundredX's Terms of Use & Privacy Policy (available at www.hundredx.com)
Should be Empty:

Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming

HundredX Causes Program Application

Your Contact Info

Prior Program Information

Organization & Program Info

Contract Signatory

Treasurer

Program Leader

Additional Program Leader