New Fundraiser Form
*Required
Non-Profit Fundraiser Information
Referring Distributor ID Number
This 4 or 5 digit number can be found at the top of the warranty card on the inside of your insole package, written on the marketing materials you received from a Distributor, or on the website you are visiting. If you do not have one leave this field blank.
*Name of Person Filling Out this Form
*Name of Non-Profit Organization
*Street Address
Street Address 2
*City
*State or Province
*Country
*Zip Code or Country Code
*Phone Number
*Email
*Confirm Email
*Where Did You First See Foot Relief Insoles or Related Products?
This question helps us determine which Distributor will get credit for referring you.
Questions or Comments
Non-Profit Eligibility Verification
*Are You a Registered Non-Profit Organization?
Yes - The Non-Profit Organization whose name appears on this application is registered and currently active.
*Please Enter Your Non-Profit Organization EIN Identification Number Here
You are required to provide this number before we can setup your Non-Profit Fundraising Account and Website.
Non-Profit Organization Statement of Eligibility
*Non-Profit Organization Statement of Eligibility Acknowledgement:
I Have Read and Agree to the Non-Profit Organization Statement of Eligibility
You Must Agree to the Non-Profit Organization Statement of Eligibility by Checking the Button Above. Otherwise do not submit this form.
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