Discount Fundraiser Signup

Fields marked with an asterisk (*) are required.

Customer Address Commission Check Address
* First Name
* Last Name
* Address
* City
* State
* Zip
* Email
* Phone
* Commission Check Payable
(We can not write checks to an individual for this fundraiser. You must enter an organization or school name here)
* First Name
* Last Name
* Address
* City
* State
* Zip
Additional Information  
School Info
Greek Organization
Graduation Year
Discount Code Information
* Discount Code
(enter as ALL CAPS)		 Every customer that uses your code online at Greek101.com will receive a 5% discount off the product total before shipping charges. You will receive a 5% commission on that customer's order.
* Password
(at least 6 characters)