Name

Phone

Email Address

Organization Name

Number of Vehicles

Type of Fleet Type of Fleet Auto Sales Vehicle Rental Other

Select a Package Select a Package Liquid Frosting™ Candy Coated Ceramic Glaze™ Crazy Glaze™ No Glaze™

Message

Name

Association to Organization

Organization Name

Organization's Website

Tax ID / Tax Exempt ID

Phone

Email Address

Street Address

City

State StateALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip Code

Fundraiser Option Fundraiser OptionOption 1: Pre-Sell ProgramOption 2: Pre-Paid ProgramOption 3: Partial Payment Program

Type of Organization Type of Organization Non-profit Community Projects Church & Synagogue Groups School Sports Organization Other

Has your organization conducted a Glaze Car Wash Fundraiser in the last 12 months? Has your organization conducted a Glaze Car Wash Fundraiser in the last 12 months? Yes No

Please tell us a little about your organization