Emch Fundraising, LLC
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Thank you for your interest!
Please fill out this form completely and accurately to sign-up for a new fundraiser.
Fields marked with * are required.
Please do not fill out this form if you are not from Kansas or Missouri.
Contact Information:

Group Name *
Your Name *
Title
Mailing Address *
City *
State *
Zip *
Home Phone *
Work Phone
Cell Phone *
E-Mail *
Group Web site address

Sale Information:
Have you run a sale with us before? Yes  No
Choose one of our fundraising programs :


Requested Start Date: *
Requested Return Order Date: *  Generally 2-3 weeks after the start date
Date you will submit order *  Generally 1-3 days after the orders are returned
Delivery Date/Time Your sales representative will contact you to discuss a delivery date and time. Delivery will usually be between 10-14 days after we receive your order.
# of order forms needed *
Checks payable to:
Fundraiser Purpose: *
Do you need posters? Yes/No Yes  No *
# of participants in your group *
The order forms will be mailed or dropped off generally one week in advance of your fundraising start date. If you need them at a different time please note that in the comment section below. We also suggest that you give your group an incentive to help reach your goals. Incentives have been proven to increase sales substantially! Visit our Boost Your Sales page for ideas. WE WILL PRINT THE INCENTIVE ON YOUR ORDER FORM FOR YOU!

Delivery Information:

Check this box if your Delivery Address is the same as your Mailing Address
Address *
P.O. Box
City *
State *
Zip *
Work Phone
Cell Phone
Special Notes and On-Site Delivery Instructions:
For verification purposes, using uppercase letters please type EMCHFR in the following space prior to pressing "submit"



Thank you for giving us the opportunity to serve you!

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