| Name of Group: * |
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| Address of Group: * |
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| Approximate Number of Sellers: * |
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| Is your group Tax Exempt?: * |
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| Name of Contact Person: * |
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| Home Phone Number of Contact Person: * |
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| Cell Phone Number of Contact Person: |
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| Contact's Email Address:: * |
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| Mailing Address of Contact Person: * |
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| Approximate dates you wish to do a fundraiser: * |
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| Other Comments or Information: |
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| How did you discover us?: |
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