OnTime Fundraiser

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  Your Contact Information
Account Type:*
Campaign/Organization/Company Name:*
First Name:*Last Name:*
Email Address:*
Billing Address:*
City:* 
 
State:*Zip:*
Business Phone:*Home Phone:
Cell Phone: 
 
Website URL:*
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  Which service are you interested in?
Basic Service ($0 set-up fee)
Deluxe Service ($299 set-up fee)

  Account Information
Can you accept corporate contributions?:*
Yes No
What is the maximum amount you can accept?
$

If the service you selected has a set-up fee, please enter in your credit card or bank account information.
  Option 1: Pay by Credit Card
Card Type:
Card Number 
(no spaces or dashes)
Exp. Date: (month & year) 
CVV Code:  
(3-digit code on back of card)
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  Option 2: Pay by Bank Account
Name on Bank Account:
Bank Account Type:
Routing Number: 
(9 digits)
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Account Number: 
(17 digits)
Name of Bank:

  Terms of Agreement
 By checking this box, I agree to the terms in the document:  Terms of Agreement (click the link to view)
 
Accept Credit Cards

 

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