FUNdraising Information Request Form

Organization*

First Name*

Last Name*

Contact Phone Number*

Your Email Address*

Title

Address

Street

City

State

Zip

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*

Additional Notes

Enter the security code shown*

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

Greece, NY
300 Paddy Creek Circle
Greece, NY 14615
(585) 621-1620

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