Community Rewards Group Enrollment Form

PAYMENT & GROUP REBATE PERCENTAGE

1% rebate on quarterly purchases made between $0-$899.99

2% rebate on quarterly purchases made between $900-$1799.99

4% rebate on quarterly purchases made between $1800-$5999.99

Checks will be mailed quarterly.

GROUP INFORMATION
Group Name*
Street Address (No PO Boxes)*
Street Address Address Line 2 City State ZIP Code
Phone Number*
Group Federal Tax ID Number (9-digit TIN/EIN)*
COORDINATOR INFORMATION
Name*
First Last
Coordinator Email*
Coordinator Phone*
GROUP TYPE (choose one)
Private School (including parent group, foundation, booster, on campus sports league)
- Pre-School
- Elementary
- Middle
- High
Public School (including parent group, foundation, booster, on campus sports league)
- Pre-School
- Elementary
- Middle
- High
Non Profit, Community, Civic, Religious, Sports Organization
CAPTCHA

GROUP INFORMATION