Site Information

Web Site Name:    

Web Site URL:    

Contact Information

Full Name:    

Title in Organization:    

Phone Number:    

Email Address:    

Organization Information

Organization Name:    

Mailing Address:    

Phone Number:    

Tax ID (SS/EIN):    

Type of Organization:         Select an organization type... Charity Church Fraternal Organization Governmental Agency Hospital/Clinic Political Organization Professional Association Religious Organization School Volunteer Service Other

I have read the Support My Cause Service Agreement and I am at least 18 years of age.

I certify that to the best of my knowledge the information in this application and requested documents submitted to Support My Cause is correct.

 
Signature: Type your name.