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Fundraisers
Requested Information
Fundraisers are held on Monday, Tuesday or Thursday. Fundraiser applications are approved based on fully completed applications and date availability. Requests must be submitted at minimum 2 weeks prior to requested date.
Name of organization (check made payable to):
Group/Organization name reflected on fundraising materials (your fundraiser coupons):
Street Address (where you would like the check mailed to):
City
State
- Choose an Option -
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
Organization's Tax ID number (required):
Contact Person Name:
Contact Person Phone Number:
Contact Person E-mail Address:
Please select a date (must be Monday, Tuesday or Thursday):
January
February
March
April
May
June
July
August
September
October
November
December
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31
In the event that your first choice is not available, please select a second date (must be a Monday, Tuesday or Thursday):
January
February
March
April
May
June
July
August
September
October
November
December
01
02
03
04
05
06
07
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19
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21
22
23
24
25
26
27
28
29
30
31
Number of people estimated to attend
- Choose an Option -
25+
50+
75+
100+
Choose a location:
- Choose an Option -
Batavia
Fairmount
Erie Blvd
Rochester
Cicero
Amherst
Clarence
Liverpool
Vestal
Cheektowaga
Clarks Summit
Watertown
Is your organization a qualified 501 (C)3 organization?
- Choose an Option -
Yes
No
If you answered yes, please read and sign this notice: In order to conform with Internal Revenue Code Section 170(f)(8), our organization states that it did not provide goods and services in consideration for this gift. (To sign- please type your name)
How did you hear about our fundraising opportunities?
Please enter additional comments and questions below:
I understand that by signing below, I am authorizing someone to contact me in regards to Fund Raising opportunities with Tully’s Good Times. I also understand that by returning this form, Tully’s Good Times is under no obligation to hold the Fund Raiser. If we agree to schedule the Fund Raiser, the organization that I represent will not hand out Fund Raiser Coupons on the premises or in the parking lot at any time. Doing so may result in cancellation of the event. I give permission to Tully’s Good Times to use my organization’s name and donation amount from the above event in response to media inquires. (To sign- please type your name and date)
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522 East Main St., Batavia, New York 14020 TEL: (585) 343- 9030
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