PoloxJazz 2026 Non-Profit Affiliate Marketing Information Form
Please fill out your details for you and your organization
.
Organization Details
Organization name
*
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
EIN / Tax ID Number
*
Social Media Accounts
*
Platform: @Handle; Platform: @Handle;
Organization Representative Details
Organization Representative Name
*
First Name
Last Name
Organization Representative Email
*
example@example.com
Contact Number
*
Organization Logo
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Affiliate Payout Preference (Select one)
Check
Direct Deposit (provide banking info)
Donation Credit
Payment Info (Bank Name, Account, Routing – if applicable)
Marketing Lead Name / Title
Preferred Commission Category
Tickets
Sponsors
Donors
Vendors
Other
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Vendor's Representative Signature
*
Submission Date
-
Month
-
Day
Year
Date
Print Form
Submit
Submit
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