Apply for Our Fundraising Program

Name of Group/Organization: (as should be stated on Order Forms)


Group Coordinator:       Phone:

Address:

City: State: ZIP:

START DATE:         

END DATE:

Expected PRODUCT PICKUP/SHIP DATE: 

Number of Sellers:

Who would you like checks made payable to?

Which sizes would you like to sell?
Pint Jar - $17/each (earn $8.50/candle) 
Half Pint - $10/each (earn $5.00/candle)
Country Sampler - $7/each (earn $3.50/candle)
Qubes - 3/$15 each (earn $5/per pack)

Are you interested in purchasing sample display kit(s) at discount rate? (If yes, indicate that we will contact you for details).
Yes No

Please explain briefly how your proceeds will be used:


EMAIL ADDRESS: