FUNdraising Information Request Form

Name: The Distillery Restaurant
Price range: $$$

Organization**

First Name**

Last Name**

Contact Phone Number**

Your Email Address**

Title

Address

Organization Phone Number*

Fax

Organization Type**

If Other, please identify status

Has this group participated in a Distillery FUNdraiser in the past?**

How did you hear about our FUNdraising program?**

Purpose of FUNdraiser**

I would like to have a FUNdraiser in**

At this Distillery Location**

Rochester - Mt. Hope

Henrietta

Victor

Syracuse - Dewitt

Additional Notes

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Rochester, NY
1142 Mt. Hope Avenue
Rochester, NY 14620
(585) 271-4105

Victor, NY
10 Square Drive
Victor, New York 14564
(585) 425-2337

Henrietta, NY
3010 Winton Road South
Henrietta, NY 14623
(585) 339-3010

Dewitt, NY
3112 Erie Blvd. East
DeWitt, NY 13214
(315) 449-2337