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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):
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):
In the event that your first choice is not available, please select a second date (must be a Monday, Tuesday or Thursday):
Number of people estimated to attend
Choose a location:
Is your organization a qualified 501 (C)3 organization?
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