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?
Has your organization participated in a HundredX Causes program before?
Is your organization ok with receiving funds via ACH
Prior Program Information
Can you log into your Bill.com account?
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?
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 and run for 30 days. Mid-month programs begin on the 3rd Monday of the month and run for 22 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?
How do you communicate with your supporters? (Check all that apply)
Who will be the contract signatory for this program?
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.Format: (000) 000-0000.
Who will be the Treasurer for this program?
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.Format: (000) 000-0000.
Does your organization meet the requirement for tax exempt status as determined by the IRS?
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
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Are there any Program Leaders who should also have access to the program for planning purposes?
Program Leader
Program Leader Name

First NameLast Name
Program Leader Email
example@example.com
Program Leader Phone
Please enter a valid phone number.Format: (000) 000-0000.
Program Leader Role in Organization
Are there any other Program Leaders who should also have access to the program for planning purposes?
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.Format: (000) 000-0000.
Additional Program Leader Role in Organization
Terms & Conditions
Should be Empty:

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HundredX Causes Program Application

Your Contact Info

Prior Program Information

Organization & Program Info

Contract Signatory

Treasurer

Program Leader

Additional Program Leader