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**

At this Distillery Location**

Greece

Henrietta

Rochester - Mt. Hope

Syracuse - Dewitt

Victor

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