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Choclatique Fund Raiser Request Form

Please note that this form must be completed in its entirety in order for your group's request to be considered.
Your fundraiser is only considered approved when you receive your event approval code from Choclatique. All requests must be submitted at least 6 weeks prior to the requested fundraising event date. You will be contacted within 2 weeks of receipt of your Fundraiser Registration Request Form.
Organization Name:
Contact Name:
Contact Phone Number:
Contact Email Address:
Organization's Web Address:
Description of Organization's Mission,
Membership, Activities:
Taxpayer Identification Number:
Payee Name:
(To Whom The Check Should Be Made Payable)
Mailing Address For Fundraiser Check:
(Checks are mailed within 2-weeks after the fundraiser event date)
Desired Date of Your Event:    
How Did You Hear About Our
Fundraiser Program?
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