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Charlie’s Fundraiser Application
Charlie's location where you will pick up your donation check.
(Required)
Select Location
Independence, MO - E 40 Hwy
Lee's Summit, MO - Chipman Rd
Lenexa, KS - 87th St. Pkwy
Liberty, MO - N Church Rd
Olathe, KS - S Black Bob Rd
Overland Park, KS - Metcalf Ave
Overland Park, KS - Shawnee Mission Pkwy
Topeka, KS - Wanamaker & Huntoon
Wichita, KS - W 21st
Wichita, KS - W Kellogg Dr
Wichita, KS - N Rock Rd
Warr Acres, OK - Nw Expy
Yukon, OK - NW 10th
Name of Organization
(Required)
Make Check Payable to
(Required)
This field should be identical to the W-9 you will be asked to submit in a later step. The IRS requires us to collect a W-9, even if your organization is tax-exempt. Note: a 1099 form will be issued if applicable.
Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Contact Name
(Required)
First
Last
Contact Email
(Required)
Enter Email
Confirm Email
All fundraiser details will be communicated to this address.
Contact Mobile Phone
(Required)
Requested Fundraiser Month
(Required)
January
February
March
April
May
June
July
August
September
October
November
December
Fundraisers start the first of the month and end the last day of the month. Please choose a month 45-90 days from today.
Logo Submission
Organization Logo
Accepted file types: jpg, png, Max. file size: 300 MB.
A logo is not required but can be added and is suggested especially if it is recognizable by your friends and family.
Terms and Conditions Acknowledgement
Terms and Conditions Acknowledgement
(Required)
Please read and acknowledge the following statements.
I am an authorized signor for the above organization and enter into this agreement with their full consent.
I will submit Photo ID & Organization W-9 prior to application acceptance.
I understand Logo cannot be added unless submitted with this application.
The URL and QR code issued to us will only be available during the fundraiser dates.
Funds will be released to our organization within 30 business days after the fundraiser ends.
I will show proof of identity, acknowledge donation, and participate in a check presentation with photo and image release.
Acknowledgement
(Required)
Type full name to acknowledge and accept Terms and Conditions.
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