This form is to be completed by School Administrator or Parent Fundraising Group member in a leadership role only.
Your Name:
Title/Position:
School/Organization:
Number of Students:
Phone:
Alt. Phone:
E-mail Address
Delivery Address:
Where would you like the apples to be delivered?
Street Address:
City:
State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NMo
NY
NC
ND
OH
OK
OR
PA
PR
RI
SD
SC
TN
TX
UT
VT
VI
VA
WA
DC
WV
WI
WY
Zip:
Your Mailing Address:
Where is the best place for us to send any communications if different from
Delivery Address?
Street Address:
City:
State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NMo
NY
NC
ND
OH
OK
OR
PA
PR
RI
SD
SC
TN
TX
UT
VT
VI
VA
WA
DC
WV
WI
WY
Zip:
Fundraiser Start Date:
PLEASE NOTE: Schools have the opportunity to implement the fundraiser at any time this spring. A 2-week window is recommended. The paper apples will have a June 30, 2003 expiration date.
# of $2 RED Apples:
[recommendation = 3 red apples per student]
# of $5 GOLD Apples:
[recommendation = 2 gold apples per student]
Proposed use of funds raised through this program: