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Fundraiser Form

Please note this form must be fully completed to be considered for a fundraiser evening.

A fundraiser is only considered scheduled once you receive confirmation from the General Manager of your local Juice It Up location. All requests must be submitted at least six weeks prior to the requested fundraising event date. You will be contacted within three weeks of receiving your Fundraiser Request Form.

Organization Name
Check made payable to
Taxpayer Identification Number
(For some entries, this is the Employer Identification Number)
Mailing Address for Fundraiser Check
(Checks are mailed within 4-6 weeks after the Fundraiser date)
City/State/Zip

/ /

* Required * Required * Required
Please Tell Us About Your Organization (Fundraising Goals, Membership, Activities, etc.)
Contact Name
Phone Number (555-123-1212)
Email
Day/Date of Event - Monday, Wednesday or Thursday evenings only (enter dates as __/__/__ ).

First Choice Second Choice

* Required * Invalid date format * Required * Invalid date format
How Did You Hear About Our Fundraiser Program?

Approval of this agreement is solely at the discretion of the General Manager of your local Juice It Up Location. Fundraiser Agreement may be terminated and/or cancelled at anytime during the term of this agreement with 14 days written notice of either party. No guarantees or warranties of any kind are made by either party as to the success of the event.
I agree to and accept the above terms. * You must agree and accept the above terms to proceed.

Please make sure you have fully completed the form above. All fields are required.