Fractured Prune Of New Jersey Fund Raising Application Form  
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Email *
Organization Name *
Organization Address *
Phone Number *
Organization State Tax ID# ( if any)
Contact Information Name
Contact Information Phone Number
Purpose Of Fundraiser ( if your fundraiser is not for the benefit of your organization or if you are a for- profit organization, please indicate the organization/cause that will benefit from proceeds of your fundraiser) *
Benefiting Organization Organization/Cause Name *
Proposed Date of Fundraiser ( need 14 day notice) *
I certify that I represent the organization applying for Fractured Prune fundraising products, that I have read the accompanying qualifying requirements and we meet the guidelines as stated and that any proceeds from any re- sale of fundraising products purchased by this organization will be used for the purpose stated above and not for individual/commercial gain or profits *
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