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Datasheet
After filling out this datasheet, you will receive an email & be forwarded to our website to start ordering your sales aids.
Fields in
bold
are required.
Organization Information
Organization Name:
Sponsor
:
Fundraising Chairperson:
2006 Customer?
Yes
No
If Yes, 2006 Chairperson:
If Yes, Customer ID:
Fundraising Chairperson Information
Full name:
Primary Phone:
Cell Phone:
Work Phone:
Email:
Address
Address:
City or Town:
State:
Please Choose a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Conneticut
Deleware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massuchusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip code:
Treasurer
Treasurer (Alt Contact):
Treasurer Phone #:
Delivery Information
Name of Destination:
Contact Person:
Home Phone:
Cell Phone:
Work Phone:
Address:
City or Town:
State:
Please Choose a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Conneticut
Deleware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massuchusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip code:
Preferred Week of Delivery
Northern Tier States**
AK, CT, ID, IA, ME, MA, MI, MN, MT, NE, NH, NY, ND, OR, RI, SD, VT, WA, WI, WY
Preferred Week of Delivery:
November 12th - November 16th
Middle Tier States**
AR, CO, DE, DC, IL, IN, KS, KY, MD, MO, NJ, NC, OH, OK, PA, TN, UT, VA, WV
Preferred Week of Delivery:
November 12th - November 16th
November 19th - November 21st
Southern Tier States**
AL, AZ, CA, FL, GA, LA, MS, NV, NM, SC, TX
Preferred Week of Delivery:
November 26th - November 30th
December 3rd - December 7th
Twin Cities Metro Area
Preferred Day of Delivery:
Nov:
Dec:
5
6
7
8
9
12
13
14
19
20
21
23
26
27
28
29
30
3
4
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14
Late Order Program
(orders due Nov. 15th)
Preferred Week of Delivery:
December 3rd - 7th Only
No pre-payment is required for the products supplied to sponsored fundraising organizations by Mickman Brothers.
*
You and your Organization agree to pay 50% of the invoice price for the products and freight charges within 14 days of receipt of shipment, and the balance by December 26, 2007, or net 30 days, whichever comes first. Mickman Brothers assumes most material has been presold and not ordered on speculation. Therefore no credits will be issued for unsold products. If we are not paid on time as agreed, we will add service charges on unpaid sums of 1 1/2% per month.
Please check this box if you agree to our terms.
This will act as your signature.
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