Start your scratchcard fundraiser NOW by filling out the information below. Fields marked with an asterisk (*) are required to process your request. Use your mouse or "TAB" key to move to the next field. Do not hit "enter", or your request may not be processed properly. Click on the "Submit" button when your form is complete.

*Your Name:
Group/Organization: 
*Address:
*City:  *State: -- AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IO KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY *Zip:
*Email:
*Telephone:
Fax:

*How many cards do you want to order?:
Goal you wish to reach:

How would you like to pay for your scratchcards? Enter your choice - REQUIRED I will enter my credit card info below I will call you with my credit card info I will mail a check/money order when order my confirmed

Complete ONLY If paying for your order by credit card online. Otherwise, leave this section blank.
Credit card info (if applicable): Card: Please select one Visa Mastercard American Express
Card Number:  
Expiration Date: MM/YY:
Credit card information is kept strictly confidential and will not be kept on file after transaction is complete. Shipping charges are included in the price.

Tax exempt number for your group:
Note: If you live in KY and do not have a tax number, you will be responsible for KY sales tax of 6%

Start date of fundraiser:
End date of fundraiser:

Ship to address: (if different from above - NO P.O. Boxes)
Name:
Address:
City:  State: -- AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IO KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PN RI SC SD TN TX UT VT VA WA WV WI WY Zip:
Ship to phone #:

*How did you hear about 1Fundraising.com?:
Please select one 123Fundraising.com Fundraising Yellow Pages The Fundraising Directory Search Engine Referred by a friend The Fundraising Bank The Fundraising Bazaar Banner Ad Other

*Note: Due to the delicate scratchable coating, scratchcards cannot be returned.