FUNDRAISING  INFORMATION  REQUEST

                                                I  AM  INTERESTED  IN:

                                                Getting Started With A Gourmet Coffee Fundraiser Immediately

                                                Receiving A Complete Gourmet Coffee Fundraising Information Kit By Mail

                                                A Call From A Gourmet Coffee Fundraising Representative

                                                CONTACT & MAILING INFORMATION:

                                                      Organization Name:

                                                                             Title:

                                                                  Your Name:

                                                                       Address:

                                                                              City:    

                                                                             State:      Zip Code:

                                                              Phone Number:     Email:

                                                OUR NEXT FUNDRAISER WILL BEGIN IN APPROXIMATELY:

                                                    Immediately    1-3 Months    3-6 Months    6-9 Months    9-12 Months

                                                WE WILL HAVE THE FOLLOWING NUMBER OF PARTICIPANTS

                                                                                                                                                         THANK YOU