Please fill out the form completely as all categories require an answer. Please PRINT OUT THIS FORM BEFORE HITTING THE SUBMIT BUTTON at the bottom of the form for your records. An invoice will be sent upon receipt of the form. At the bottom of the form you will be able to choose your payment options.
Christina Roberts manages the cooperative marketing program. Once your form is received, she will send a confirmation email with your completed package and the price. If you have questions please call her at 607-936-0704 or email at firstname.lastname@example.org.
Thank you again for your participation and partnership!